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    Whilst the meanings of hashtags can be immediately obviously, such as #EndPJParalysis, some meanings are possibly less obvious.

    Yesterday, my timeline was littered by pictures of socks celebrating the #socksfordocs campaign. My immediate reaction on Twitter was this.

    But thankfully somebody sent me a private message to explain the background to the campaign.

    The background to this particular campaign is pretty amazing, and my reaction was to post a tweet with this picture this morning on my Twitter @dr_shibley.

    The history is important for me. I have found campaigns about mental health pithy and largely from professionals who’ve had no personal experience of the sheer mental torture of mental health problems (important caveat: to my knowledge). A hashtag campaign is a nice way to ‘paper over the cracks’, especially in being seen to campaign about something, such as the mental health of doctors.

    “Promoting the wellbeing of the workforce” has become a nice catchy slogan for some of the managerial class, but the reality was far from that.

    Whilst being a junior physician in distinguished London teaching hospitals more than fifteen years ago, I was developing an alcohol dependence syndrome, in which I had no insight.

    I remember one physician at a well known centre for postgraduate medical training in London, itself known for a suboptimal working culture. He told me over breakfast how I really should really book myself into the Priory, but did not offer any more details than that. He then went onto write a damning witness statement for the GMC, and later stood to be elected in the BMA Council elections.

    I remember the witness statement of another physician, personally known to the physician above as they had somehow trained together, being read out in one of my GMC hearing days. It referred to me looking ‘dishevelled’ and ‘smelling of alcohol’. This witness statement arrived at the door of the GMC two years after I left. I was offered no professional help in that NHS Trust either. Two consultants were asked to produce witness statements for the GMC from that Trust; one of them recently indeed stood to be President of the Royal College of Physicians (but thankfully lost).

    Amazingly, I was allowed to complete my 2 six-month jobs with them whey KNEW I had an active problem. Patient safety?

    The General Medical Council never asked me for my experience of being alcoholic as a junior doctor. I have done much reflection on this following the events, particularly since I have never worked in medicine ever since. But for the NHS Practitioner Health Programme, there had have been literally nobody apart from my own treating Psychiatrist on my side.

    The General Medical Council all the time claims that it never engages in guerrilla warfare to get people off their register. As it happens, coincidentally, a flurry of reports designed to induce a moral panic, but which never included reference to my mental illness, appeared, so I had to face a double stigma – a double stigma indirectly which I experienced while waiting for my 2006 GMC hearing for two years, and the stigma of my alcoholism. The cover up, including the journal of my trade union, was complete in its lack of proper discussion of the severity of my alcoholism, as that would have ruined their story. Nonetheless they continue to dribble out the odd item on careers and mental health.

    I think simple things might have helped at the time, for example if I had followed the GMC code of conduct in being disclosing to a GP about my problems. But at the time it was totally unsafe to disclose to your GP about mental illness anyway, because of the torrent of investigations which would then be launched by the GMC. While you are under investigation by the GMC, you then of course have to notify any employer.

    The intense hostility I experienced from the institutions within the medical “profession” is one which I will never forgive the profession for, and I don’t think I should ever want to work for them ever again. There’s a sense to me some of the members of it want it to be some form of Aryan race, only to represent the purest of the pure. But this is as ‘science fiction’ as the notion that registered doctors never make any mistakes.

    So, what’s this got to do with #SocksforDocs?

    It turns out the suicides of three young Doctors in New South Wales in Australia led to calls for a review of ‘mandatory reporting laws’ which can stop doctors from seeking help.  It is reported that Professor Brad Frankum, president of the Australian Medical Association (NSW), has said that he has been aware of three young doctors in training who had taken their lives, as well as two senior doctors and a young medical student.

    “They were going to save many lives and do great things, and that potential is lost,” he said.

    The timing of the two year wait for the GMC I experienced in 2004-6 is relevant. By the time of my hearing in 2006, I had already on one occasion tried to commit suicide by going on a massive binge.

    A GMC review of 28 doctors who died by suicide while under fitness-to-practise investigation between 2005 and 2013 was damning. Analysis presented elsewhere continues to look fairly at whether these suicides were preventable.

    How much morbidity and mortality has to be tolerated? A newly qualified GP voted ‘Trainee GP of the Year’ hanged himself after fearing he would be struck off by the GMC for failing an alcohol test, according to an inquest. According to a report, a young doctor, 34, had been warned by the GMC not to drink after he self-referred for ‘other issues he was having’, which resulted in restrictions on his practice, the court heard.

    32 is the year I had my hearing with the GMC. A year later, having been off the register, which I spent mostly sitting in a pub drowning my sorrows, I was admitted to the Royal Free as an emergency, having sustained a cardiac arrest and epileptic seizure. I spent 6 weeks in a coma, and became disabled.

    But thankfully I am still alive, and caring now for my mum full-time, as she has dementia. In fairness to me, I have published various medical books, as I have a keen interest in medical education.

    I think the way the medical profession, including regulation, deals with mental illness is actually corrupt to the core. The medical profession largely does not wish to admit that mental health problems exist within its workforce, as it sees mental illness as a question of blame and fault. The regulator does not believe in rehabilitation at all., but only in retribution It only is interested in the ‘red meat’ of a hostile environment to placate its Daily Mail readership. It does not believe in a learning culture, but does believe in the perks of being employed at its institution. The whole culture is totally sick; for example, the GMC has only just announced the launch of its review into why black and minority ethnic doctors are more likely to face complaints from employers than their white colleagues.

    As for me? I could never be happier. I am respected for who I am, and doing the job which matters to me – looking after my mum.  I owe the medical profession absolutely nothing, and I have successfully completed  my pre-solicitor training, my Bachelor of Law, my Master of Law (with commendation) and my Master of Business Administration.

    And much to the disgust of the complainants, I am now on the GMC medical register with a full license-to-practise currently.

    All of the complainants against me were white and middle class.

    It has been reported that

    Chief executive Charlie Massey has used a speech at the British Association of Physicians of Indian Origin (BAPIO) conference this weekend to announce the review, which will be led by two experts in leadership diversity.

    Speaking to Pulse, Mr Massey said the work would look at ‘elements of conscious and unconscious bias’ and ‘workplace cultures’.

    Euphemisms if ever I heard them.

     

     

    [NOTE: I dedicate this blogpost to @williamwyhuang.]

     

     

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    The disgraceful failure by the private sector to provide vulnerable addicts with the safest and best quality treatment available was exposed at the end of last month in a damning report issued by the Care Quality Commission (CQC).

    72% of private providers of residential-based detoxification were found to have been failing in at least one of the fundamental standards of care that everyone has a right to receive. Shamefully, providing ‘safe care and treatment’ was where the CQC found the most breaches: 63% of providers failed to meet this standard at the time of their first inspection.

    Detoxification under clinical supervision is often the first stage of a person’s addiction treatment. Often difficult and unpleasant, it is vital that they receive the best possible treatment to support their onward rehabilitation and recovery.

    And yet systemic faults were found in the way these services are provided by the private sector. Many were basic and entirely avoidable errors.

    No alcohol for me

    For example, some staff were caught giving paracetamol to people within their care more frequently than every four hours, despite the heightened risk of liver damage among heavy alcohol users. In other cases, staff failed to plan how they would manage fits during withdrawal, despite knowing that the people in their care were at risk of having seizures.

    Training in basic life support, consent, mental capacity and safeguarding were all found to be severely lacking. At times staff were found to be administering medication, including controlled drugs like methadone, without the appropriate training or being assessed as competent to do so.

    This is extremely serious. People undergoing residential-based medical detoxification from alcohol or drugs often have complex physical and mental health problems alongside their addictions. According to the Royal College of Psychiatrists, the potential dangers of erroneous detoxification include fits and hallucinations, suicide risk and risk of prescription opiate drug overdose.

    That’s why it is essential staff looking after these vulnerable patients are properly trained, follow national clinical guidelines and have appropriate 24-hour medical cover.

    So what explains this appalling failure?

    My own research in September revealed that the Tories have cut vital alcohol and drug treatment programmes by £43 million this year, forcing many people to turn to the independent sector for help. These cuts are part of wider damaging public health cuts, to the tune of £800 million by 2021.

    Specifically, 106 local authorities are reducing their drug treatment and prevention budgets this year, with a combined cut across England of £28.4 million. Similarly, 95 local authorities are reducing their alcohol treatment and prevention budgets this year by a total of £6.5 million. Equally concerning, services for children needing help with drink and drugs will be slashed by £8.3m across 70 town halls.

    Last month the Children’s Society revealed that parent’s alcohol abuse is damaging the lives of 700,000 teenagers across the UK. Frustratingly, at a time when demand for councils’ children’s services is rising, severe funding cuts from central Government are leaving more and more families to deal with these huge problems alone.

    Yet without support at an early stage as problems emerge, families can quickly reach crisis point and the risks for the children involved grow.

    The children of addicts must not be forgotten and supporting them is a personal priority of mine. Having grown up with an alcoholic father, I’m acutely aware that as a society we simply aren’t doing enough to deal with the effects of addiction.

    We know that children growing up with an alcoholic parent can often themselves go on to develop problems with alcohol or drugs or suffer mental health problems.

    That’s why during our party conference I reiterated my pledge to implement the first ever national strategy to support children of alcoholics and drug users.

    We also mustn’t ignore other forms of serious addiction. My colleague Tom Watson, Labour’s Deputy Leader, has powerfully exposed the Government’s abject failure to treat problem gamblers.

    According to the Gambling Commission the number of people with a serious habit has risen to 430,000, with a further 1.6 million at risk of developing a problem.

    And yet, shockingly, the government has no idea how many problems gamblers are being treated by the NHS or how much their addiction is costing. Like alcohol and drug addiction, we must start viewing gambling addiction as a mental health problem and not a moral failing.

    Theresa May’s mishandling of Brexit and her narrow majority in the Commons has left her with little ability or inclination to tackle these ‘burning injustices’ across society. Addiction treatment services have unquestionably suffered as a result.

    Forcing people to turn to inadequate private sector treatment is entirely unacceptable. That’s why Labour will continue the fight to ensure our health and care system, including addiction services, remains public, free at the point of use and there for all who need it.

    First published by Our NHS

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    As a child I and my whole family were badly affected by my father’s addicted habit of betting and my mother in particular had to manage at times on very little amount of money to feed, keep warm (heat) and cloth us on because of such I have a great hate for any form of betting and am supporting this that I forward to you for your consideration.

    However, betting can easily become a mental illness and whilst some may not see the true affects that this can have on families, it’s cost to the communities and the NHS has to be given greater consideration. So please do have a look at this.

    This morning the government made an announcement that could change lives. They’re talking about cracking down on betting machines that are so addictive they’ve been dubbed the “crack cocaine” of gambling.

    Packed into high streets up and down the country, these machines suck up life savings and turn people’s lives upside down. Now, the government’s at a crossroads. They could decide to drastically reduce the amount of money people can bet – or they could tinker around the edges.

    Right now the minister in charge of gambling, Tracey Crouch, wants to know what the public thinks. She’s weighing up her options, working out whether she’s got the backing to change the law so that no one can lose their life savings in a single afternoon.

    A huge petition signed by hundreds of thousands of us could be enough to show that the public’s behind her. Will you join me and sign the petition?

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    Whether e-cigarettes can help address health inequalities will depend on take-up in deprived communities – but cost and ‘faff’ are discouraging deprived smokers from switching, according to new research.

    The study involved community-based research in the North East of England with smokers and quitters over three years from 2012 to 2015. Research participants bought both tobacco and electronic cigarettes largely through informal outlets and personal networks – but for the very poorest, cost was a barrier to any e-cigarette use. Although £10 would buy a starter tank and e-liquid, smokers could get a week’s worth of illicit rolling tobacco for the same money. The poorest could not risk such a large outlay on something that might not work.

    nov-14-ecig-market-pic-for-sha-blog-nov-16
    Figure 1: People bought from informal outlets

    Even those who could afford better tended to buy cheap e-cigarettes (and cheap tobacco if they were still smoking) because addiction was a problem for their moral identity, as was excessive expenditure on the self. Older people were particularly likely to be put off by the association of the e-cigarette with pleasure or play, and avoided aspects of e-cigarette use which they associated with frivolity or self-indulgence: sweet flavours, expensive parts, vaping shops, culture and language.

    Users struggled with the faff factor

    Users struggled with the time, effort and expense involved in finding the ‘right’ e-cigarette and the frequency of product failure i.e. cheaper tank models splitting, leaking, or bubbling if over-tightened or dropped, and problems with batteries running out or failing to charge. Unless users were highly motivated to quit, smoking was easier and cheaper taking into account the cost of e-cigarette replacement and the availability of illicit tobacco.

    This practical problem was also a gender issue. The energy, time and money needed to switch successfully to e-cigarettes were often lacking for older women heavily invested in family care, whose personal health was relatively low in their hierarchy of concerns. Mature women in the study had a relational sense of identity in which care of the self was at the bottom of a hierarchy of concerns. For these women, their own health simply did not seem important enough, in comparison with the many tasks they did for others, for them to put in the effort needed to quit. As a result, whilst they might try an e-cigarette, they quickly became impatient with aspects in which it compared poorly with the ever-reliable, endlessly replaceable cigarette.

    Figures currently show slightly more women than men using e-cigarettes overall. Women are more likely to use disposable or first-generation ‘cigalikes’, but since second-generation devices deliver nicotine more effectively and are more satisfying to users, there is a risk that using less effective models may translate into fewer women ceasing to smoke. Gender is not discussed in the most recent UK e-cigarette evidence review; further research will be needed to establish whether there is a gender differential in the use of e-cigarettes to quit smoking successfully.

    Young men bought into vaping culture

    Smoking cessation conflicted with a local ethic of working-class hedonism which encouraged sociable smoking and drinking, particularly among younger men. This meant that to abstain or quit smoking was to risk being seen as pretentious or insufficiently masculine. However, using an e-cigarette overcame this problem, not least because an interest in gadgets and technology was a legitimate male trait. The e-cigarette was therefore a viable masculine accessory in combining hedonism with technology.

    Local masculinity was performed differently in mature adulthood, at which point smoking cessation could function as part of a narrative of family responsibility or indeed of mastery; older men positioned their e-cigarette use within this functional narrative. Normative masculinity also required that one should give up smoking if suffering serious ill-health such as cancer, stroke or heart attack; not to do so in such circumstances implied weakness or a lack of self-control. Some men with serious health problems who were unable to quit smoking remained dual users of tobacco and e-cigarettes, but deployed e-cigarettes as a badge of moral intent.

    The success of the e-cigarette in addressing health inequalities will partly depend on whether it enables users to overcome locally normative barriers to cessation. These findings suggest that it does have some potential to do this, at least in relation to men. However, the e-cigarette is constantly changing and increasingly regulated; should it become a more medicalized product, it might lose its attractiveness as a masculine accessory. On the other hand, if more reliable and effective models start to dominate the market, this will diminish the trial and error process which discourages older women users in particular.

    Whilst the findings of this study cannot be generalised to deprived areas across the UK or further afield, local meanings of smoking and cessation in relation to gender and age are crucial to e-cigarette take-up, as are place-based smoking and cessation practices more generally. Most importantly, we need to appreciate that local norms can sometimes make giving up tobacco or taking up e-cigarettes more of a risk to moral identity than carrying on smoking.

    The full article is open access and available here:
    Thirlway, Frances (2016). Everyday tactics in local moral worlds: e-cigarette practices in a working-class area of the UK. Social Science & Medicine 170: 106-113.

    About the author

    Frances Thirlway is a Research Associate at Durham University and an associate member of FUSE – the UKCRC Centre for Translational Research in Public Health. Her research interests are in health, class and culture, with a particular interest in smoking cessation (including e-cigarette use) in relation to health inequalities in the north of England and in Scotland. Follow her @fthirlway

     

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    The mental health and smoking action report

    Despite many years of progress, smoking remains still the single biggest cause of preventable and premature death in England killing almost 80,000 people every year.

    What is more, smoking is a leading cause of inequalities. Smoking rates amongst people with a mental health condition are particularly concerning. Around one third of adult tobacco consumption is by people with a current mental health condition and whilst less than 20% of the general population smoke, this figure is around 40% in those with a mental health condition, and up to 70% in people discharged from a psychiatric hospital.

    This difference in prevalence has dire consequences. People with mental health conditions die on average 10-20 years earlier than the general population and smoking is the single largest factor in this shocking difference. People with a mental health condition are just as likely as other smokers to want to quit, but because they are more likely to be heavily addicted to smoking, they need more support to be successful. This support is sadly lacking: when ASH asked smokers with a mental health condition if anyone providing inpatient care had offered them help to stop smoking two thirds told us no one had. Clearly there is an urgent need for action.

    ASH has published a new report entitled The Stolen Years: The mental health and action smoking report setting out the urgent action needed to get smoking rates falling in this population. The report has been endorsed by 27 leading mental and public health organisations, including Rethink Mental Illness and the Royal College of Psychiatrists and has been informed by a wide range of people, from experts by experience to those working in mental health, public health and the NHS.

    Our ambition is that smoking among people with a mental health condition declines to be less than 5% by 2035, with an interim target of 35% by 2020. This is an undeniably ambitious target and there is no single measure that will help us get there. Key areas identified in The Stolen Years for action include:

    • National targets and leadership to drive action across the country
    • A strong focus on the skills and training of the workforce
    • Availability of evidence-based services alongside peer support for all those who need them
    • Better access to the medications that will help people to quit
    • Improved understanding that electronic cigarettes provide a less harmful alternative to smoking
    • Moving to smokefree mental health settings alongside provision of the right support to smokers

    The publication of this report is only the start of work on this agenda. After decades of stagnation, change is only possible with collective action. If we are to achieve our ambition and drive real change in this area all parts of the health and social care system from national government through to local authorities, the NHS and care providers will need to play their part. Failure to act now would be to condemn thousands of people with a mental health condition to early death and debilitating disease and would widen the already appalling gap in life expectancy.

    ASH is a public health charity that works locally, nationally and internationally to try and achieve a vision: a society free from the harm caused by tobacco. You can access “The Stolen Years: the mental health and smoking action report” here.

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    How do they fit into the public health agenda?

    The growing prevalence of non-communicable diseases (NCDs) is triggering substantial policy concern, evident, for example, in the 2011 UN high level meeting on NCDs. Yet, it’s clear that there are very different ways of thinking about this ‘epidemiological transition’. For some, including the current UK government it seems, the rise in such diseases is viewed primarily as a consequence of the choices that individuals make. In contrast, many of those working in public health understand the problem to be largely a consequence of the strategies that corporations pursue. These different views lead to different conclusions about appropriate and effective responses.

    For those who take the view that the growing NCD burden is a consequence of economic development (via, for example, more sedentary and unhealthy lifestyles), then it’s logical to focus policy responses on trying to inform the choices that individuals make. From this perspective, we can all ‘choose to be healthier’ by doing more exercise, eating healthier foods and avoiding, or limiting, our consumption of health-damaging products such as tobacco and alcohol.  The CEO of Pepsi Co, Indra Nooyi, endorses this viewpoint, arguing that PepsiCo is an ‘ethical’ company because it provides consumers with a choice of products, ranging from healthy to less healthy.

    This emphasis is frequently reinforced in the media through advertising, news stories and television programmes that promote the idea that individuals choose unhealthy lifestyles, and via a focus on individual-level solutions to improve health. From this viewpoint, corporate interests involved in the production and marketing of health damaging products should be ‘part of the debate’, or even ‘part of the solution’ to the emerging health crisis (e.g. via reformulated products, changing labelling and implementing self-regulatory codes).

    Yet, if we turn to tobacco, a sector which has been extensively researched for several decades now, a very different approach is evident. Here, the prevailing view in public health and increasingly in policy, is that the tobacco industry is a primary ‘vector’ of the growing NCD burden. Investigative journalism and research centring on internal tobacco industry documents has made public the extent to which senior managers of tobacco companies have (amongst other things): lied about the addictiveness of nicotine, worked to make their products more addictivetargeted young children as ‘new markets’; and worked to limit tobacco control policies.

    Consequently, the political and public legitimacy of tobacco industry actors has plummeted, triggering some desperate efforts to regain a seat at the policy table. Analysis of a European Union consultation on smokefree legislation has demonstrated that we are now at a stage (at least in the EU) where tobacco industry actors are almost entirely separated from public health policy debates – although the rise of e-cigarettes is beginning to challenge the cohesiveness of the tobacco control movement. In part, this reflects public health efforts to ‘denormalise’ tobacco and routine business practices of the tobacco industry; efforts which have gained particular traction in the UK. The clear differences in perception of the tobacco industry, on the one hand, and the food and alcohol industries on the other, warrant deeper consideration: why are these three industries perceived so differently and is this distinction justified?

    How different are the tobacco, alcohol and processed food industries?

    There are two obvious ways in which it might seem appropriate to distinguish between tobacco, alcohol and food industries. First, we might consider that the harms associated with tobacco products are greater than those associated with alcohol and food. Yet, assessments of the contribution of alcohol and obesity to adverse health outcomes (e.g. adverse pregnancy outcomes) suggests they are often as high as tobacco. Likewise, comparative estimates of the costs of alcohol, tobacco and ultra-processed food often suggest the costs are similar and, in fact, probably higher for food-related problems, such as obesity. So this first rationale seems unconvincing.

    A second reason concerns the behaviour of the industries. It is certainly the case that more is known about the efforts of tobacco companies to misrepresent research and to shape policy in their interest than is known about the efforts of alcohol and food companies. But this is beginning to change. For example, in his book Lethal but Legal Nicholas Freudenberg shows that the practices of these industries in marketing, product design, lobbying, and sowing doubts about evidence of harm are remarkably similar.

    640px-Bulgogi_burger

    How different are the processed food and tobacco industries? (Credit: Alan Chan CC BY-SA 2.0)

    These similarities are also evident in research examining alcohol industry efforts to influence policy in the context of minimum unit pricing debates in the UK. Like the tobacco industry, the alcohol industry pursues highly integrated strategies and employs many of the policy-influencing tactics identified within the tobacco industry, including extensive lobbying at all stages of the policy process, the use of thinks tanks and front groups, attempts to shape the scientific content of policy debates, and to influence public perception of their industry and policy proposals. Again, such tactics are evident in work which has compared, for example, how tobacco and soda companies have used corporate social responsibility campaigns to influence the political landscape. In fact, the soda industry goes even further than tobacco in its explicit goals to increase consumption and target children. This suggests that commercial strategies to influence public and policy debates are very similar across industry sector. Hence, the second rationale (different industry behaviour) doesn’t seem valid either.

    Yet, in interviews I have undertaken over the past four years, the view that tobacco represents a radically different case from alcohol and food seems deeply engrained in the way many policy makers, researchers and advocates think. It seems likely that this is at least partly a result of importance attached to individual-level behaviour in neoliberal economies but it may also reflect the success of ‘tobacco exceptionalism’, a core tenant of which is the idea that other industries are different from tobacco and not necessarily worthy of the same, strict rules to protect public health policies from industry interference. This has worked well for tobacco control advocates in the UK so far but may have unintended consequences for other dimensions of public health.

    A new interlinked public health agenda: assessing the role of industry

    If we are serious about tackling the rising burden of NCDs then we need to revisit the popular and persistent distinction between tobacco, alcohol and food industries. From a research perspective, the following five questions seem like a good place to begin better understanding, and perhaps challenging, widely held distinctions between the various industries involved in producing and marketing unhealthy commodities:

    1. What are the interactions between the actors that constitute each of these industries and how close are these connections?
    2. How similar are food and alcohol industry approaches to influencing public, political and policy debates to tobacco? (Since these industries have not had to provide access to their internal documents on the same scale as tobacco, we need to develop innovative methodologies and find new data sources.)
    3. How do members of the public and key policy actors view each industry and their products and why? Does this appear to vary by context or change when presented with different kinds of evidence?
    4. What are the potential policy alternatives that might contribute to achieving healthier future scenarios and how do these differ across alcohol, tobacco and food?
    5. Reflecting this, to what extent can the case study of tobacco control be used to provide lessons for developing and implementing evidence-based policies to promote and protect people’s health beyond tobacco?

    These suggestions are, of course, simply a means of contributing to this emerging debate. What seems essential is that we begin to develop a new research agenda in public health, and policy and politics more broadly, which frees us from our current silo-based view of these interlinked public health problems.

    First published on the British Politics and Policy blog

    These colleagues contributed to the piece: Professor Oliver Razum, Dean of the School of Public Health at Bielefeld University, Germany; Professor Nicholas Freudenberg, City University New York; Dr Lori Dorfman, University of California, Berkeley, Dr Benjamin Hawkins, London School of Hygiene and Tropical Medicine,Dr Shona Hilton and Dr Heide Weishaar, MRC/CSO Social and Public Health Sciences Unit, University of Glasgow.

     

     

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    Current legislation has created an environment where the link between organised criminals and the most vulnerable is strong and almost freely exploitative. Despite all the efforts to reduce the supply and the demand, drug misuse continues, and we must ask: what we can do differently. If the aim is to stop people taking drugs, and stop people committing crime in order to fund their habit, we must follow the evidence and support people to recover rather than send them to prison.

    REDUCING SUPPLY-PAST FAILURES

    Enforcement agencies, over time, have had pockets of success in seizing significant quantities of drugs, but this has not limited the long-term supply. This is largely due to the fact that the criminals have altered their supply routes and methods, and exploited changing technologies such as the dark web and postal services (such as track my parcel), and it is now more common for suppliers to exploit the postal service by sending drugs more frequently in smaller quantities- no longer do we see over 100kg seizures of Class A drugs entering the UK.

    As a former police officer, I have lost count on the number of large scale early morning raids that I have participated in. Yet, the simple truth is that these activities-which take months, sometimes years in the planning- do no more than disrupt the supply market for the very shortest of periods. In one undercover policing operation which took 6 months to plan, cost over £0.5 million and saw 30 people arrested for their involvement in the supply of Class A drugs, 2 recovering addicts who had been arrested were asked how long we had strangled the supply of Heroin; one estimated 4 hours and the other estimated 2. The principal reason is supply, demand and profit.  With steady demand from addicted people, dealers move into the market place.

    And even if we do succeed in reducing the supply of drugs, the demand is still there. So I have no doubt that that demand will be filled, possibly by New Psychoactive substances or other chemically produced drugs. We must reduce demand.

    REDUCING DEMAND-DECRIMINALISATION

    What we need is a means of making the market in controlled drugs less lucrative. This requires a different approach; one that reduces demand for the product. Addicts should be treated and supported into recovery, removing them as consumers. Their entrapment in criminal justice is a waste of police time, a waste of public spend, does not help addicts to recover, provides a continued market to dealers, and dissuades addicts from revealing themselves for treatment for fear of the criminal consequences.

    The strategy of decriminalising addiction, in order to support recovery, would be the most effective in avoiding their route to criminality.  If we take Colorado as an example, since the regulation of cannabis, the state has benefited from a decrease in crime rates, a decrease in traffic fatalities, an increase in tax revenue and economic output from retail cannabis sales, and an increase in jobs.

    HEALTH-BASED APPROACH in COUNTY DURHAM and DARLINGTON

    The crux of the strategy we are working towards in County Durham and Darlington involves redefining the problem- individual drug addiction- as a health and community safety issue, not a criminal justice issue. The Police already work in partnership with Directors in Public Health to deliver strategies that work whilst continuing to target the organised criminals who seek to make a profit by shattering the lives of others.

    Durham is leading the way nationally for the ‘Drug Test on Arrest’ initiative which is rolled out across all of the force’s custody suites and is using equipment that indicates not only heroin or cocaine use, but other controlled substances as well. It allows the Force to steer a number of users away from the criminal justice system and towards health-based resolutions with the end aim of supporting recovery. Testing is carried out on people arrested for certain “trigger” offences, such as dishonesty crimes including shop thefts, burglaries and robberies. As of 16.02.15, there have been 711 tests completed; within these tests, only 135 people have tested negative for no substances, this represents 19% (1 in 5) of all people tested.

    The Women’s Diversion Scheme in Durham and Darlington offers a credible alternative to prosecution for many low level adult female offenders, focusing on why the subject has offended and seeks to address those issues to prevent reoffending. Out of 158 women who took part in the scheme, 62% have not gone on to reoffend, and of those who failed, a further 64% of those who had been offered the scheme but failed to engage had reoffended.

    Developing this further, Durham Constabulary has introduced Checkpoint. It is potentially a revolutionary way of tackling reoffending.  It is a culture changing initiative for the police and partners. The intention under this initiative is to provide a credible alternative to prosecution by intervening at the earliest opportunity to prevent someone from offending again. The programme offers a ‘contract to engage’ for the arrested person, based on the critical pathways of offending. Specialist navigators will identify underlying lifestyle issues linked to offending and divert them away from the Criminal Justice System by signposting them on to appropriate services. Failure to engage or complete the contract will trigger the prosecution procedures to continue as they would normally do.

    CONCLUSION

    We can’t go on telling kids that if they take drugs it will ruin their lives, with the follow up being that if we catch them taking drugs we will ruin their lives. We must move away from the criminalisation of addicts, and focus on treatment and recovery. We should be focusing on the best way to minimise harm, and help these people recover from their addiction, so that we can improve their life chances, help them make a positive contribution to society, and cut off the income streams of the organised crime groups-the real criminals making money out of others’ misery.

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    Bristol today became the first city in the UK to ban smoking in outdoor public places.

    Anti-smoking campaigners installed signs in two busy outdoor spaces – Millennium Square and Anchor Square – after a poll found 61 per cent of locals were in favour.

    Keep Bristol Smoke Free

    The pilot scheme will see smokers asked to stub out cigarettes when in the two areas, but it will be up to each individual bars and restaurants if they choose to comply.

    The project by Smokefree South West was inspired by mother Kirsty Vass, 33, who was diagnosed with chronic obstructive pulmonary disease a year ago. Ms Vass, who smoked 20 cigarettes a day for more than 15 years, suffered a collapsed lung and is now constantly short of breath and has to be supported by her daughter Lucy, 15. The mum from Torbay, Devon, said: “My smoking illness has caused my whole world to come crashing down. “If young people see you smoking then they think its alight, but they don’t understand what it can do to you, so making smoking less visible in public places can only be a good thing. “I don’t want other people to be like me because this isn’t a life, it’s a life sentence. If I can make people realise that this is what smoking does to you then please, please, please quit now because it’s really not worth it, especially if you’ve got kids.”

    A study of 1,000 people conducted by Smokefree South West revealed more than four out of five people have encouraged a friend or loved one to quit smoking. More than half said that the fact their friend or loved one still continued to smoke made them feel anxious, with more than one in ten complaining that their worry kept them awake at night.

    New York, Toronto and Hong Kong, have already banned smoking in some popular outdoor locations and it is hoped the scheme could be embraced by other UK cities.

    Fiona Andrews, director of Smokefree South West, said: “This is an exciting initiative that we hope will have a lasting impact on not just Millennium Square and Anchor Square, but the wider region and potentially the rest of the UK. “These city centre squares are often full of children playing and this pilot will provide a smoke-free environment for kids and their parents to enjoy. “We know that most smokers want to quit but often put it off until it’s too late to avoid serious damaging disease or early death. We all know smoking kills but somehow we think it will kill ‘other people’ not us. For those who are close friends of a smoker or who love them this can be very hard and even frightening to live with. Smoking has a dramatic emotional impact on friends and family members, on top of the well documented damage caused by passive smoking, which is especially harmful to children who breathe it in more rapidly.

    “The message is simple, if you don’t want to quit for your own health, then take that step to do it for the health of your family and your relationships, as your loved ones are desperate to help you quit, but often feel powerless to do so. The trick is to keep setting a date to go smokefree. Powerful campaigns that help bring home just why it is worth stopping, and then help show them how to quit, help to spur smokers on again to break free of tobacco. We are saying to all smokers in the south west: evidence shows 1 in 2 of you will die early of a tobacco-related disease, but it doesn’t have to be that way for you.”

    Bristol was named European Green Capital for 2015 and assistant mayor for public health Daniella Radice said: “I am excited to see how this pilot can change people’s habits and make Bristol an even more enjoyable place to live and to visit.”

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    Shadow Cabinet Sub-Group – Society (March) Public Health

    This document was published by the Daily Mail, but it appears to be genuine.

    This paper looks at four big drivers of population health that are the focus of much public health, policy, and which must be priorities for the next Labour Government:

    1. Physical activity
    2. Food consumption
    3. Alcohol consumption
    4. Tobacco consumption

    For each, it sets out a proposal for an ambition for the next Labour government, along with a range of possible policy commitments to improve public health in these areas.

    In choosing to focus on these four issues, the paper does not attempt to cover other important topics in public health policy, which are nevertheless being addressed in our wider policy review work, including a range of services that are considered part of public health policy, such as sexual health services, cancer screening or drug treatment programmes; other drivers of population health such as air quality or water quality: immunisation; the broader context of social and economic policy, which is an important underlying determinant of public health; and mental health, where there are strong links with a range of public health issues. Public mental health is being addressed by the Taskforce on Mental Health in Society (see Box 2).

    The problem

    The environment in which we live, and the way we live our lives, has a profound impact on our health. Many health problems have environmental and behavioural causes, with levels of physical activity, and the consumption of food, alcohol and tobacco among the key ones. So improving our health as a nation will require action on these issues.

    Better public health policies are needed if the NHS is to survive

    This is not only important for improving health. Left unchecked poor public health will impose substantial costs on the health service and the wider economy. NHS England estimates that the NHS faces a £30bn funding gap by 2020 (against a flat real baseline), and even optimistic estimates of savings from possible productivity improvements within the NHS fall well short of filling this gap

    So improving public health will be an essential part of ensuring the NHS remains sustainable for the next generation. Demand will rise faster if people do not do what they can to prevent avoidable illnesses themselves, and the long-term capacity of the NHS to treat everyone who needs it will be at risk without a focus on prevention as well as cure.

    In particular, pressures on the NHS are not only generated by a growing and ageing population, but also by a rise in the prevalence of conditions and chronic diseases related to the way we live our lives. For example, the substantial recent growth in the level of those who are overweight or obese has begun to translate itself into the increases in the levels of diabetes – with the total number of adults with diabetes in England projected to rise from 3.1 million in 2012 to 4.2 million by 2030. Unless firm action is taken to halt the rise in diabetes, the proportion of the NHS budget spent on treating the condition and its complications Is likely to rise from approximately 10% now to 17% by 2035/36 – which is totally unsustainable. And when the indirect costs of diabetes are added in, such as inability to work and the costs of caring, the total cost to the UK is set to rise from £23.7 bn in 2010/11 to £39.8 bn in 2035/36.

    Better public health policies are needed to empower people and protect children

    People make choices every day that affect their health but they are not always able to make those choices under circumstances of their own choosing and making healthy choices can be especially difficult if people are not supported in doing this.

    And this is especially true for parents and children. Nothing is more important to parents than their child’s health, yet this can be made all the harder by commercial pressures and advertising. Too often the system seems stacked against parents who want to ensure their child eats healthy, nutritious food.

    Better public health policies are needed to tackle health inequalities

    As well as improving overall population health, public health is especially important for tackling health inequalities. There continues to be a substantial and persistent gap between the health outcomes for different social groups – for example, the large geographical and social gradient in life expectancy at birth ranges for men from 74.0 years in Blackpool to 82.9 in East Dorset, and for women from 79.5 years in Manchester to 86.6 in Purbeck.

    One Nation frame

    Helping people improve their health and that of their family is central to Labour’s mission. We want government to be on people’s side, supporting them in making healthy choices and improving their health.

    Children’s health is an area where a robust role for government is sometimes required, given that children do not necessarily have the same capacity or freedom to make choices as adults. In particular, children’s health is an arena where there should be limits to markets – and where government has a crucial role to play in supporting parents who are trying to do the right thing.

    And government must take a proactive approach to tackling health inequalities such as differences in life expectancy or Infant mortality. We cannot be One Nation when health inequalities are so wide.

    The Tories

    The Tories cannot provide the answers on public health. Too often they are unwilling to stand up to vested interests or are ideologically opposed to Intervening In markets. Their capitulation to Big Tobacco over standardised cigarette packaging, not long after employing tobacco. More generally, there has been real reluctance on behalf of the Coalition Government to develop strategies and plans to improve the health of the population. Their decision to rely solely on industry self-regulation and voluntary initiatives (the ‘Responsibility Deal’) is widely seen to have been ineffective and can penalise companies who want to do the right thing. This process has largely lost credibility as professional bodies have withdrawn from it due to the domination of the agenda by commercial interests.

    The Tories are also in denial about the health impacts of their wider social and economic policies, from unemployment and job insecurity to indebtedness and reduced financial support for families- And there is little leadership across Whitehall on public health: the way in which Michael Gove has downgraded the children’s health agenda within the Department for Education has been particularly damaging, with the abandonment of successful initiatives such as the Every Child Matters agenda and the Healthy Schools Programme.

    Tackling health inequalities: Lessons from the Marmot Review

    In 2008, Labour commissioned the Marmot Review of Health Inequalities, Fair society, Healthy lives, which identified six key policy objectives for tackling health inequalities:

    • Give every child the best start in life
    • Enable all children, young people and adults to maximise their capabilities and have control over their lives
    • Create fair employment and good work for all
    • Ensure a healthy standard of living for all
    • Create and develop healthy and sustainable places and communities
    • Strengthen the role and impact of ill health prevention

    There were also two key lessons in the Review for public health policy that we strongly endorse:

    The first is the principle of ‘health in all policies’ – putting health concerns at the centres of our programme for government. Good health is not created by the Department of Health, nor by the actions of the NHS; it is the product of many separate policies and activities in not just government departments but in communities, schools, workplaces and homes across the country. Successful policy must build a systematic approach that mobilises all of the relevant government departments, local authorities and community and voluntary groups to contribute to a broadly based approach to improving the health of the population.

    The second is the principles of ‘proportionate universalism’. Our key goal is to reduce health inequalities but focusing solely on the most disadvantaged will not make a big enough difference. We need to take universal action on what are the major problems affecting our health, but with a focus and intensity that is proportionate to the level of disadvantage In different communities and groups

    National ambitions and policy options

    In order to improve the health of the population measurably in the course of one parliament Labour needs to develop a dynamic public health programme that can be swiftly implemented.

    This paper concentrates on four major public health priorities that would form a central part of that programme. In each case we think action should be guided by a new ‘national ambition’, backed by some eye-catching policy proposals. Those ambitions would be the focus of a partnership approach between government, communities and individuals themselves.

    On proposals, as public health policy is concerned with environmental and behavioural factors, rather than simply health services, possible actions here relate to a variety of different policy areas. At this stage they are presented as options for discussion.

    1.   Physical activity

    Physical activity is the thread that runs across a range of public health policy and outcomes. Lack of physical activity and sedentary lifestyles are associated with a wide range of physical and mental health conditions: daily physical activity is associated with an approximately 30% lower risk of colon cancer, an approximately 20% lower risk of breast cancer, and a 20-30% lower risk of both depression and dementia. And physical activity can also be a catalyst for other lifestyle choices and changes, such as alcohol and food consumption.

    Labour had a strong record In promoting physical activity – and particularly promoting Sport for children and young people In 2002, Just 25% of children undertook two hours of PE and sport in school, but by the end of our term in government this had been raised to 93%. We also created 422 School Sports Partnerships and 2,300 School Sport Co­ordinators covering every school. The Tory-led Government ripped up this legacy, scrapping School Sports Partnerships and squandering the opportunity to build on the Olympic legacy. They also axed Labour’s school sport targets and as a result more than half of children now fail to get at least two hours of physical education every week.

    Proposed ambition:

    *   An ambition to get half of the population physically active by 2025, working with schools, business and community organisations. (We are currently looking at the best definition of physically active for this purpose).)

    Policy options for discussion:

    i.     Capitalising on the primary childcare guarantee and other extended schools initiatives, more opportunities should be created for children to participate in sport and be physically active at school. This should include a goal that all school pupils are taught how to swim and how to ride a bike safely

    ii.   Reinstate the goal of all children doing a minimum of two hours PE a week, and introduce tougher protections for school playing fields

    iii. A special lottery fund should be established to finance the construction of small-scale community sports facilities such as skateboard parks, BMX tracks, netball and basketball courts

    iv. We should give focal authorities an expanded remit lo support physical exercise in communities. As part of this, we should look at how we can better ensure that local communities have the opportunity to use sporting facilities in stale and private schools outside school hours and terms.

    2. Food and Obesity

    In England, 62% of adults and 28% of children aged between 2 and 15 are overweight or obese. The health consequences of obesity alone are estimated to cost the NHS more than £5 billion every year and cases of malnutrition are on the rise.

    Labour in Government introduced new school food standards, the Healthy Schools Programme, and extended the provision of free fruit and vegetables to school children. By contrast, the Tory-led Government has removed the obligation for academies and free schools to abide by nutritional standards and abolished the Healthy Schools programme.

    Proposed ambition:

    • An ambition to reverse the growth in cases of malnutrition and to improve the health of children, including reducing childhood obesity.

    Policy options for discussion:

    1. We should introduce regulations to limit the levels of fat, salt and sugar in products marketed substantially to children
    2. Food marketing to children via television should also be curbed by a 9pm watershed for the marketing of products high in fat, salt or sugar, along with a review of controls on internet content aimed at children
    3. A standardised system of traffic lighting of packaged food in respect of its nutritional content should be introduced and backed by regulation.
    4. Supermarkets and shops above a certain size should not be permitted to stock confectionery and other unhealthy foods adjacent to check out tills

    3. Tobacco

    Tobacco is the largest cause of preventable illness and death. There are about 10 million adults who smoke cigarettes in Britain, around 20% of the population. Every year smoking causes around 100,000 deaths and it is also a major driver of health inequalities – smoking rates are markedly higher among low-income groups (33% amongst people in routine and manual occupations).

    ONS surveys show that two-thirds of smokers want to quit. Helping someone quit is not only good for their health, but their finances too: if they smoke 20 cigarettes a day, then helping them quit puts over £2,000 back in their pockets each year.

    The proportion of adult smokers fell from 28% to 20% between 1998 and 2010, due to a series of national initiatives including the ban on smoking in enclosed public places and the raising of the legal age for buying tobacco from 16 to 18. Other significant steps forward were tough legislation on vending machines and tobacco advertising at point of sale, while we also expanded NHS Stop Smoking Services, supporting hundreds of thousands of smokers to quit.

    Proposed ambition;

    • By supporting people to quit smoking and helping young people avoid starting, an ambition to reduce smoking prevalence to 10% by 2025. Over the longer-term we should have as a goal that children born in 2015 will become the first smoke-free generation for hundreds of years

    Policy options for discussion:

    1. If not already in place, standardised packaging of tobacco products and a ban on smoking in cars with children will be introduced immediately
    2. A push to encourage tobacco education programmes, including peer-based programmes, in secondary schools
    3. There should be a new Initiative by HMRC, in conjunction with police forces and regional offices for tobacco control, to stem the trade in Illegal tobacco
    4. The Labour Party should commit to becoming the country’s first ‘tobacco-free’ political party, rejecting sponsorship or donations from the tobacco industry or their front organisations.

    4. Alcohol

    After tobacco, alcohol is regarded as the next most important avoidable risk lo population health. Excessive drinking is associated with a wide range of chronic disease including liver disease, cardiovascular disease and cancer, as well as with crime and disorder. It Is estimated that up to 35% of all A&E attendances and ambulance costs may be alcohol-related, and that up to 70% of A&E attendances at peak times on the weekends (between midnight and 5am) may be alcohol-related.

    The Tory-led Government initially committed to introduction of minimum unit pricing, and then reversed their position. On the other hand, the Government has committed itself to reduce total population alcohol consumption by one billion units per annum.

    Proposed ambition:

    • An ambition will be set to reduce the overall population consumption of alcohol in addition to reducing the proportion of the population who consume above the recommended level

    Policy options for discussion:

    i.   A pricing mechanism, such as minimum unit pricing or an alternative, should be developed both to reduce the availability of high-alcohol, low-price ‘booze’ which is used for pre-loading, but also to halt the shift in alcohol sales from pubs to major supermarkets

    ii.   The promotion of alcohol through the sponsorship of sport should be phased out during the course of the Parliament

    iii. The positioning of alcohol retail space in supermarkets should be regulated – for example, being limited to a single defined area on each premise / physically distant from the front doors

    iv. A review of licensing should be undertaken to promote a new power to raise a charge to cover the cost of additional staffing required to maintain public order and safety where needed: strengthen powers to refuse or withdraw licences to sell alcohol on public health grounds and enhance the voice of local communities in licensing decisions

    Mental Health

    BOX 2 – Taskforce on Mental Health In Society

    Good mental health doesn’t start in hospital or the treatment room; it starts in our workplaces, our schools and our communities. So we need a mental health strategy outside as well as inside the National Health Service.

    For that reason, the Taskforce on Mental Health in Society, led by Stephen O’Brien was set up to explore how society needs to change to prevent mental health problems and promote good mental health, and how we can better support those affected by or recovering from mental health problems in society.

    The Taskforce is therefore looking at mental health in some of the major contexts in which we live our lives: home, community, school and workplace.

    Three findings have consistently emerged from the work they have done in these areas:

    1. Population mental health: A wide variety of social factors can affect mental health, so interventions to address these and build resilience to them can promote good mental health and help to prevent mental health problems
    2. Early Intervention and action. Early help and support to tackle problems upstream is far better both for the individuals and families affected and for the country as a whole than allowing problems to develop
    3. Supporting those living with mental health problems: There already exist inspiring examples of how people living with mental health problems can be supported to live full and flourishing lives, but we need a radical shift in attitudes, policy and practice if we are to make this a reality for all

    The Taskforce is looking at how these principles apply in homes, communities, schools and workplaces, both at the current problems that exist and the opportunities to be grasped if we act. They will report in Spring 2014.

     

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    The Daily Mail claims to have a copy of proposals from the Shadow Cabinet subgroup on health.

    They say the Labour health blueprint includes:

    • A total ban on the current £300 million sports sponsorship by drinks firms.
    • Minimum alcohol price to stop ‘pre-loading’ by young drinkers.
    • Banning supermarkets from selling drinks near the door, or sweets at the tills.
    • New laws to curb the amount of sugar, fat and salt in food aimed at children – and a 9pm watershed  for TV adverts for unhealthy products that might appeal to youngsters.
    • Lottery cash to build skateboard parks.
    • Aiming to get half the population to take regular exercise within ten years.
    • A goal that children born from next year will be the ‘first smoke free generation’.
    Daily Mail view of Labour public health policy

    Daily Mail view of Labour public health policy

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    If you smoke, you’re going to be well aware of the health benefits of quitting, but are you fully aware of the difference that giving up smoking can make to your finances?

    Don’t underestimate the financial benefit of giving up cigarettes; quitting smoking will save you money, and lots of it!

    If you’re struggling to find the motivation to stop, then looking at the amount of money you could save should really help. If you needed any more convincing just look at the science – recent research has shown that your chance of successfully changing a health-related behaviour increases by 50% if there’s a financial reward at the end of it. Apply this logic to smoking and simply putting a price on quitting should help you quit for good.

    The good news is that you don’t have to go through it alone; there are plenty of places you can go for free support, and the products that make it easier to stop smoking aren’t expensive either.

    How much will you save on cigarettes

    The average cost of a 20 pack of cigarettes is currently £7.98, according to the charity Action on Smoking and Health. This means smoking 20 cigarettes a day costs you around £2,900 a year! If you think that’s expensive it’s only set to rise further with increased duty on tobacco. The British Heart Foundation website has a useful tool that lets you calculate how much money you could save if you quit smoking. Just enter the number of cigarettes you smoke to see how much better off you would be each week, month and year. Put a price on your habit then think about what else you could spend this extra money on. Then when you’re tempted to reach for a cigarette, just focus on this instead and hopefully it’ll help you resist.

    Other ways you’ll save by quitting

    Aside from the actual savings you’ll make by not buying cigarettes, stopping smoking will save you money in other ways too.

    Cheaper insurance

    When you don’t smoke life insurance is cheaper; your premiums could drop by as much as 50% once you have been smoke free for 12 months, for exactly the same amount of cover. Once you’re officially a non-smoke everything from your private healthcare insurance to income protection cover and even your home and car insurance could be much cheaper – all because you’ll be treated as a lower risk. When you successfully quit, let your insurance providers know this to start enjoying the benefits of reduced premiums. When you’ll be classed as a non-smoker will differ from insurer to insurer (it could be right away, it could be 3 years smoke-free) but the sooner you tell them, the sooner you’ll have the added incentive to stick with it.

    Better health = less time off work

    Once you quit smoking you should feel healthier and be less likely to take time off work. This will have a positive impact on your income, particularly if you are self-employed. Quitting smoking before it causes you serious health problems that impact your earnings is another financial motivator to kick your habit.

    What about the cost of quitting smoking?

    If you’re reluctant to try quitting over concerns that the products you’ll need to help you quit smoking are pricey – especially if you aren’t successful – this needn’t be a worry. Some quit smoking aids are available free of charge and for those that you pay for, it still works out a lot cheaper than paying for cigarettes each week. We take a look at just how cheaply you can stop smoking.

    Support for quitting smoking: Cost = Free

    Help with quitting is available free from NHS Stop Smoking advisers. Your GP can refer you for a one-to-one appointment or you can self-refer by phoning your local service directly. Besides helpful tips and support to help you with your quit attempt, these advisers can also help you get stop smoking medications and nicotine replacement therapy for a cheaper price. If you’re unable to get to a clinic near you, the NHS Stop Smoking App is available free via iTunes, which sends you daily motivational messages, as well as providing tips and access to a wealth of useful information. Additional free advice is also available online from sites such as NHS Smokefree, Quit and ASH and you can pick up a free NHS Quit Kit from your local pharmacy or order one online from the NHS website – these have tools to further increase your chances of successfully quitting.

    Nicotine replacement therapy: Cost: Up to £8.05/week

    Some people find nicotine replacement therapy helps them deal with the physical symptoms of stopping smoking. It’s available to buy directly from pharmacies, but you can save money by obtaining a prescription for these from your GP or smoking cessation adviser. If you get free prescriptions you won’t need to pay a penny for these products and even if you do pay for your prescriptions, with the current charge for prescriptions set at £8.05, paying this for a week’s supply still works out around a third cheaper than buying direct from your local chemist.

    Prescription medication: Cost: On a case by case basis

    Zyban and Champix are prescription medications that can boost your chances of successfully kicking your smoking habit. They’re not suitable for everyone though and your doctor will decide whether you should try them as they do carry side-effects. In a similar way to nicotine replacement therapy, both are available at no cost if you don’t pay for your prescriptions, though you may otherwise need to pay for a course of this therapy. Zyban is typically taken for 7 to 9 weeks and Champix for 12 weeks, though this is a small price to pay if you successfully quit.

    E-cigarettes: Cost = £10-£18 per pack

    Although they are not officially recommended as a stop smoking aid, many smokers do find E-cigarettes a helpful way to quit, and the good news is that they can be cost-effective. Although you will pay anything from £10 to £90 for a starter pack, and then £10 to £18 for a pack of four refill cartridges, with each cartridge equal to 25 cigarettes, it’s easy to see how the savings soon mount up compared to the real thing.

    Complementary therapies: Cost = Free (depending on location)

    Hypnosis, acupressure and hypnosis may sometimes be available free of charge through NHS Smoking Services, though depending on where you live you may need to pay for these alternative therapies.

    Kick the habit!

    Now that you can see how much money you can save by giving up cigarettes and how little it costs to access smoking cessation support, what are you waiting for?

    Speak to your GP to find out more about the stop smoking aids that are most suitable for you and start you quit attempt ASAP.

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    When the UK Government abandoned its proposal to introduce minimum unit pricing for alcohol in July 2013, it argued there was a lack of concrete evidence that the policy would reduce the harm caused by alcohol without penalising responsible drinkers. In research published in the Lancet, the Sheffield Alcohol Research Group show minimum unit pricing avoids penalising moderate drinkers on low incomes and would contribute to the reduction of health inequalities.

    Minimum unit pricing (MUP) sets a threshold below which a unit of alcohol cannot be sold to consumers. Under a 45p MUP a pint of beer containing two units would need to cost at least 90p and a bottle of wine containing 9 units at least £4.05. Since heavier drinkers typically pay less per unit for their alcohol than moderate drinkers, and of course buy more units in the first place, this means that heavier drinkers would be affected the most by MUP.

    The impact of MUP on the poor

    In our new research, we explore the impact of MUP on those with low incomes who may be more likely to buy cheap alcohol. In particular we were interested in claims the policy could be particularly regressive by targeting drinks bought by the poor. To investigate this, we constructed a model of the relationship between MUP, people’s alcohol spending and consumption and the health risks associated with that consumption.

    We separated the population into moderate, hazardous and harmful drinkers and found moderate drinkers in the lowest income group bought very little alcohol for less than 45p per unit – less than one unit per week on average. When we estimated how much their consumption would reduce under a 45p MUP, we found it would drop by just 4 units per year – approximately 2 pints of beer. As this income group was the least likely to drink and most likely drink at moderate levels if they did so, this suggests the overwhelming majority of those on low incomes would not be substantially affected by MUP.
    Among heavier drinkers the picture was different. For harmful drinkers, a 45p MUP was estimated to have a large effect which varied substantially by income. For the lowest income group consumption would fall by 300 units per year among the 5% who are harmful drinkers, compared to 34 units in the highest income group of whom 8% are harmful drinkers.

    Reducing health inequalities

    Even though harmful drinkers with lower incomes are the group likely to be affected most by MUP, this does not necessarily mean the policy is regressive. To understand its full implications we need to look at its success in achieving MUP’s primary aim – reducing alcohol-related harm.

    For reasons which are unclear, those with lower incomes appear to suffer greater risks of harm from their drinking than those with higher incomes. The combined effect of the bigger risks and bigger consumption reductions means low income groups would be by far the biggest beneficiaries of the policy in terms of health improvements. A 45p MUP is estimated to lead to 860 fewer deaths and 29,900 fewer hospital admissions due to alcohol per year and routine or manual worker households would account for over 80% of these. On this measure, the policy can be argued to be strongly progressive.

    Minimum Unit Pricing

    Model-based estimates of policy effects are, of course, subject to uncertainty and we take account of this by using different assumptions and inputting alternative data to see what the range of plausible effects might be. Although the size of the effects varied under these scenarios, the key findings remained the same and give us greater confidence in our conclusions.

    Effectiveness and fairness

    We consistently find, across a wide range of plausible scenarios, no support for the UK Government’s concerns that minimum unit pricing would penalise responsible drinkers. This is because the estimated effects on this group are negligible, even in the lowest income groups. Instead, the policy targets those at greatest risk of harm – heavier drinkers on low incomes. As such, the benefits of the policy are also concentrated on this group.

    The reduction of health inequalities, including those generated by alcohol consumption, is an explicit aim of the Government’s public health policy. Our research shows minimum unit pricing would make an effective contribution to reducing such inequalities by particularly reducing the harm caused by alcohol in lower socioeconomic groups. It also challenges perceptions about levels of drinking among the poorest in our society and raises important questions about how we judge the fairness of public health policies.

    This BMA info graphic is based on the lowest proposed unit price of 40p. The BMA believes the minimum price should be no less than 50p per unit.

    Dr John Holmes, Sheffield Alcohol Research Group

    This article first appeared in Healthier Scotland – The Journal Published by Socialist Health Association Scotland March 2014

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