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    This Public Health Manifesto has been developed by Directors of Public Health in the North West.

    Read the full manifesto

    • Implement a minimum price of 50p per unit of alcohol to tackle alcohol related harm.
    • Implement a sugar sweet beverage duty at 20p per litre to reduce poor dental health, obesity and related conditions.
    • Commit to the eradication of childhood poverty to meet targets set by the Child Poverty Act 2010.
    • Work with employers to increase payment of the living wage to benefit both businesses and employees, and introduce a higher minimum wage.
    • Ban the marketing on television of foods high in fat, sugar and salt before 9 pm to reduce children’s exposure to unhealthy food advertising.
    • Implement the recommendations contained within the “1001 critical days” cross party report to ensure all babies have the best possible start in life.
    • Implement tougher regulation of pay day loan companies to prevent people ending up with unmanageable debts.
    • Require all schools to provide a minimum of one hour of physical activity to all pupils every day in line with UK physical activity guidelines for 5-18 year olds.
    • Implement policies to encourage active travel and use of public transport to increase physical activity, reduce emissions, increase road safety and reduce pollution.
    • Require compulsory standardised front of pack labelling for all pre-packaged food and alcohol.

    This manifesto will be used to help leaders from across the political spectrum to understand important public health priorities and will also be used locally to shape public health work in the North West now and for the future. Local members of the community, groups and local politicians are also being asked to get involved and put their name behind these priorities.

    If you would like to show your support for the Public Health Manifesto please sign up – you can select all 10 priorities or you can select those you feel most strongly about.

    1 Comment

    The Association is entitled to propose 10 amendments to the Labour Party’s proposed policies.  These are the amendments we are planning to propose after discussion at our Central Council last week. (there are 12 listed as we hope to cooperate with another affiliated society).  Suggestions for improvements are welcome, but each amendment is limited to 200 words, and they have to be submitted by 13th June.

    Amendments to Health and Care

    1. Social Care

    Page 8  line 18  In Section entitled – The future of social care.
    After second paragraph add:-
    “Labour believes that it is time to accept that social care should be placed on the same basis as health care; cover for all, contributed to by all and free at the point of need. The case for all care being free is the same as the original case for free health care.   Labour will work towards delivering on the aspiration of free care building on the Care Bill provisions which extend social free care to some.

    Policies which take away the independence of the disabled and cause deteriorating health as a consequence are costly and cruel.  An incoming of Labour Government will not implement the current Government’s proposals to end the Independent Living Fund (ILF) in June 2015 and will instead initiate a full review of disabled people’s independent living. As part of that review Labour will look to use National and local government purchasing power to drive down prices of disability related equipment and services, including insurance. Labour will also look at ways of reducing the cost of social care for disabled people and their local authorities without reducing the quality of services delivered.”

    2. Mental Health

    page 10 line 38 add: “ Britain’s mental health is at its worst since 1997 with increasing morbidity and a worsening suicide rate, because of  recession and savage cuts to public services which disproportionately affect the most vulnerable. A clear focus on enhanced well- being and the promotion of mental health within schools, workplaces and general hospitals is needed to reduce the economic and social burden of mental ill health. A new National Service Framework, with a robust set of clinical and social outcomes based on a model of early identification recovery and optimism, delivered in partnership with service users and carers will be established. Labour will instruct the Care Quality Commission to make sure that all providers of mental health and social care services comply with the Equalities Act meeting the access needs of disabled people and the cultural needs of  BAME communities. In addition, Labour will demand that all relevant authorities play an active part in improving the integration between physical and mental health services and deploy community development resources with the clear objective of strengthening the community and voluntary sector to deliver on our aspiration for better mental health and spiritual well-being for all local populations.
    Children’s mental health is paramount if psychomorbidity in the adult population is to decrease. CAMH services need to be adequate for the speedy identification and treatment of mental disorders in children in the least stigmatising way.”

    3. NHS

    Page 4 line 7 Delete second paragraph and replace with:-

    “Labour will restore the duty of the Secretary of State to deliver a comprehensive, universal NHS overwhelmingly publicly provided and entirely publicly managed and will give the Secretary of State the power to give directions to any part of the NHS.
    Labour will deliver an NHS that values and promotes collaboration and cooperation. Labour will remove any legal or other barriers which prevent or deter cooperation including any which seek to require NHS services to be competitively tendered.   Labour will replace the system of procurement through commissioning with a system where publicly funded care services are planned and decisions about services and funding are made through open and transparent democratically accountable processes drawing on experiences in Scotland (and Wales, where health outcomes on a par with England are delivered for about 10% less cash than comparable English regions).

    The NHS will no longer operate as a market or pretend that Foundation Trusts are free-standing competitive corporations.  The private sector will only be allowed to offer patient services as an alternative to the NHS by exception, where it evidences enhanced care and innovation.. ”

    4. Accountability

    Page 4 line 30 delete sentence beginning “Instead, we need…”  Insert “The health service must ensure collective and individual accountability throughout. Care must be delivered with as much participation in shared decision-making as the patient wishes at the time. Planning functions must be democratically accountable.  We will ensure the engagement of patients and family / carers in the care process as co-producers of health outcomes and the provision of good information to patients to enable them to be actively engaged. Values important to patients like dignity and respect should be demonstrated in every service provided.  This should be informed by widely available and meaningful information about the performance of and outcomes from health care services.
    Nationally, UK comparative performance in terms of health inputs, care processes and patient outcomes (both patient and clinician reported) will be used to ensure the NHS matches the performance of the best European systems. The average length of life both attained and forecast at national and sub national levels, the number of life years lost, and the quality of life in key respects (especially for the last decade of life) will inform these measures. The Chief Medical Officer (England) will be required to submit an annual report directly to Parliament charting progress in these areas.”

    5.  Public Health

    Page 10 Line 15 insert “We will make healthy choices easier by ensuring that the financial incentives and taxation system supports affordable healthy products such as fresh fruit and vegetables while making unhealthy products high in fat, salt and sugar better regulated and relatively more expensive.
    We will remove the VAT exemption from sugar, which has little nutritional value.  We will ensure that the quantity of sugar, salt and fat in manufactured food is easily apparent to customers wherever it is sold. We will ban the use of trans fats in food products (as done in Denmark) – and push for the ban to be extended throughout the EU.We will introduce minimum unit pricing and encourage lower alcohol products.  We will reduce the hours during which supermarkets are permitted to sell alcohol and make it more difficult to buy dangerous quantities of alcohol following the successful example of reducing damage caused by paracetamol poisoning. We will progressively raise the age below which it is unlawful to supply tobacco to young people.  We will bring forward proposals to reform the law on misuse of drugs to balance the penalties against the harm done by different drugs including alcohol and tobacco.”

    Amendment to  Stability and Prosperity

    6. A healthy society

    Page 4 line 8 insert “We want to see a community in which power, wealth and opportunity are in the hands of the many not the few and where the rights we enjoy reflect the duties we owe. This will not happen in an unhealthy society where wealth is primarily inherited and the benefits of economic growth go to those who are already rich.  Labour’s long-term goal is to break the link between a person’s social class and their health. We will work across government, using the power and influence of all government departments and agencies, to achieve this. All Labour’s policies in government will be subject to an assessment of their impact on the public’s health.

    We will use a new tax on wealth to finance the NHS and social care system to achieve a level of spend as a percentage of GDP on a par with the best in Europe, aided by the removal of tax rules that currently allow tax avoidance by international companies earning  untaxed profits in the UK. We will safeguard the NHS from the TTIP which will otherwise act as a means of a commercial takeover of our healthcare provision. ”

    Amendments to Work and Business

    7. Health and work

    Page 6 line 25 insert: “Employees of all grades with higher levels of control over their work (in terms of content, pacing of tasks, decision-making, etc.) have better health. Low control at work is associated with higher rates of heart disease, musculoskeletal pain, mental ill health and mortality – even when other risk factors (such as smoking) are accounted for. Interventions to improve control at work (for example rotating tasks, flexible working, employee participation in making company decisions, employee ownership/shares) have been found to improve health – with no detrimental effects on productivity. We will introduce measures to ensure that firms are  involving employees in the business so that job control is increased. In other European countries, such as Germany, “workers’ councils” are common place in businesses and they could be introduced here.”

    8. Benefits for disabled people

    Page 11  line  6 add at end “Labour will ensure there is a non means tested benefit to meet the additional costs faced by disabled people, and place them on a level playing field with non disabled people.  Pending the benefit redesign Labour will immediately revert to the 50-metre distance test in respect of the higher rate mobility component of PIP. There should be a disabled person on each tribunal considering appeals where award of the benefit has been refused.  The assessment must be accessible, fair and transparent, carried out by NHS workers, must use evidence obtained from Occupational Therapists,  doctors and other healthcare professionals, use existing assessment data held for people’s entitlement to disability living allowance where held, entitle a recipient of DLA automatically to PIP and be carried out once to result in a lifetime award unless the impact of a condition can be expected to change. There should be no cap on the budget for the benefit, so that all disabled people who meet the criteria receive the benefit.  We welcome the report of the Disability and Poverty Taskforce and will work with disabled people and their organisations to examine how its recommendations can be taken forward.”

    Amendment to Living Standards and Sustainability

    9 Transport and health

    Page 3  Line 48  Insert new heading “Transport and health ”
    Insert “Traffic accidents are higher in more disadvantaged and urban areas (particularly amongst children and outside schools), and are the leading cause of death in children over 5. We will encourage widespread introduction of 20 mph limits in urban areas to encourage the reclaiming of our streets by pedestrians.
    The Active Travel (Wales) Act 2013 will be extended to England so every local authority will be required to publish details of expenditure on transport measures divided between walking, cycling, public transport and motor vehicles.   We will rebalance the transport budget so that 10% is spent consistently over the length of the parliament on the needs of pedestrians and cyclists with the aim of building networks of segregated cycle tracks in every major city.  We will remove VAT from bicycles.
    We will take urgent steps to reduce the air pollution caused by road traffic, and in particular by diesel engines. We will reconsider the taxation of vehicles and motor fuel in the light of the evidence of damage to health caused by particulates.
    We will reduce the level of alcohol which is permitted for motorists”

    Amendment to Education and Children

    10. Healthy Children

    Page 10  Line 4 insert “In 2013 the UK had worse rates than nearly every other Western European nation for early neonatal deaths especially among socially disadvantaged groups. More investment in employing trained midwives to provide one to one care is crucial and shown to be effective in reducing still birth. We will ensure that sufficient support from midwives and health visitors is available for women and babies to tackle the appalling level of death among young children. We will increase benefit rates for pregnant women so that they can afford a healthy diet. All children are vulnerable and schools need to do much more to promote both physical and mental health. Every school must have a school nurse and a school counsellor. Childrens mental health services need to be adequate for the speedy identification and treatment of mental disorders in children in the least stigmatising way.”

    Amendments to Better Politics

    11. Community Development

    Page 4. line 24 insert. “Taking part in community activity is a vital way of protecting and improving mental health. Health providers will be directed to support the growth of local voluntary and community groups as a whole, cooperating with the other services which have a mutual interest in this. We will ensure that health agencies play an active part in deploying community development, with the clear objective of strengthening the constructive role of the community and voluntary sector in relation to health.  NHS agencies and providers will therefore be expected to play their part in ensuring that every locality has a thriving third sector largely funded by grants rather than contracts. NHS organisations will be expected to take an active part in neighbourhood partnerships and to encourage users and carers groups to do so. There needs to be a shift so that we look at the most disadvantaged people regaining a sense of hope control and optimism over their lives, working on the strengths, (assets), of people, their families and the communities in which they live – this will impact positively on mental health and well-being and is evidence based from the recovery framework that is gaining credence in mental health”.

    12. Age discrimination

    Page 8  line 46  insert new section “Age”…”We will ensure that there is parity of treatment in health and social care services in respect of both youth and  age.  This implies

    • equal access to effective, safe care
    • equal efforts to improve the quality of care
    • the allocation of resources on a basis commensurate with need
    • equal status within healthcare education and practice
    • equally high aspirations for service users
    • equal status to the measurement of health outcomes”
    16 Comments

    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.

     

    5 Comments

    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

    Tagged | 3 Comments

    The current smog – whilst unnerving for those living through it – is a welcome opportunity to focus on an under-reported scandal of modern British public health. We are being killed, silently and invisibly in the thousands, by the air we breathe. And few in Public Health, let alone the media, is noticing. Why?

    The mainstream narrative on public health this century revolves around behaviour and chronic disease. The major health challenges were tackled by the Victorians and the social reforms of the 20th Century. First sewerage and water, through factory acts and public housing, then lately the clean air act in the 1950s meant the big industrial killers and (with vaccines and antibiotics) major infectious diseases were solved. In their place we have a new set of evils – diet, exercise, smoking, alcohol and sex, particularly amongst the poor.

    Public Health England has a nice list in its priorities: “We know the most significant factors that lead to poor health: smoking; high blood pressure; obesity; poor diet; lack of exercise; and excessive alcohol consumption.”

    This shift fit with the New Right and then New Labour focus on individual responsibility and (at best) a behaviour-regulating Government. Regulation gave way to nudge. For the right, moralistic victim-blaming whilst railing at a state reduced to nannying personal choices. For the left, a doomed mission to explain the complex social determinants (and commercial pressures) driving behaviour itself.

    So it is not surprising perhaps that air pollution has gone out of fashion since the closure of heavy industry and this shift in political status quo. Until, that is, you learn (as I did today) that air pollution is responsible for 29,000 premature deaths, half a year off life expectancy and is the second biggest cause of premature death after smoking but before obesity or alcohol. In the light of these figures, the air-brushing of pollution from the priorities of public health policy is nothing short of surreal.

    Perhaps our blindness to air pollution is that, apart from this week, it is usually invisible. Perhaps, it does not fit into our understanding of post-industrial Britain where dirty industry is off-shored to the Developing world. Perhaps it is a victim of Government departmental silos, but Defra lacks the budget or (potential) clout of the Department of Health. Certainly the Treasury has been keen to dilute the Cameron Greenwash as being anti-business. But I can’t remember Labour being much louder about it – with the notable exception of Livingstone’s pioneering policies.

    Is there an opportunity here for Labour to mount a populist pro-green, pro-health attack on air pollution? Nothing apparently so far from our Public Health team, admittedly busy in pursuit of mental health, sugary drinks and plain cigarette packaging this week. Miliband made a tentative foray back into the green agenda during the floods, so following up with an attack on the Government (and Johnson’s) lamentable record would seem to be an open goal in the run up to local and Euro elections. As the UK breaches EU pollution limits, killing thousands more, what better example of the potential for progressive public health policy in Europe and in local government to bring tangible impact on life and death?

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    Transport and Health Study Group

    In 1989 seven people gathered in Manchester Town Hall to found the Transport and Health Study Group. Dr. Stephen Morton, who called the meeting, became Chairman. At the time the perception of transport professionals and public health professionals alike was that injuries resulting from crashes were the main health consequence of transport. The seven founders of the Transport and Health Study Group thought the relationship went much further. Dr. Morton had called the meeting because he perceived that the out of town shopping centres created by a car-oriented spatial planning system increased health inequalities by depriving people without cars of access to important lifestyle choices. Others present at the initial meeting spoke about community severance, heart disease caused by insufficient cycling and walking, and the contribution of transport to climate change. We saw potential for a major interdisciplinary field of study. But to envisage that field having its own journal would have seemed extremely ambitious. So would the idea that the Transport and Health Study Group might have its own Parliamentary Advisers, have a European Committee or be the centre of a professional alliance with major professional organisations. A more immediate ambition might have been to be able to mention transport and health without being suspected of insanity.

    Health on the Move was an important first step ( THSG, 1991). Prepared by discussion seminars, it was the first coherent, comprehensive account of links between transport and health. Much of it, though, was speculative. By the time Health on the Move 2 came to be written twenty years later, the evidence base had developed and we were writing a serious, scientific textbook ( Mindell et al., 2011) We won’t wait 20 years before updating Health on the Move again – we will do it in installments, revising it chapter by chapter through articles published in this journal (see editorial: Mindell, 2014).

    Debating scientific evidence and publishing definitive accounts of the body of knowledge is the first duty of a scientific society. THSG, as its name suggests, is first and foremost a scientific society. But when scientific knowledge interacts with important areas of political decision making it is not enough just to publish scientific material. It must be used to frame recommendations for action and draw them to the attention of those who need to act on them. That is why Health on the Move 2 includes a comprehensive range of recommendations, which Sir Liam Donaldson, the former Chief Medical Officer for England, kindly described as combining creativity with scientific rigour ( Donaldson, 2011).

    Active travel is the biggest single issue at the moment. The evidence that walking and cycling are good for health is compelling – entirely feasible targets for active travel are capable of contributing as much to reducing heart disease as the range of other interventions. If a pharmaceutical company invented tomorrow a drug to dramatically reduce the risk of obesity, hypertension, osteoporosis, diabetes, heart disease, and depression, and make people feel better at the same time, it would watch its share price go through the roof. Physical activity can do all these things, and active travel can also help reduce carbon emissions and congestion.

    We still find ourselves having to fight defensive campaigns, such as resisting proposals for compulsory cycle helmets which will do little for cycle safety but will have a serious adverse effect on cycling levels, not least because they feed misconceptions about cycle safety. Comparing like for like (for example accounting for age and comparing cycling around town with driving around town not with overall driving statistics dominated by long safe motorway journeys), the risks of cycling are comparable to those of driving (Mindell et al., 2012). For most age groups cycling is slightly more risky but only to a degree which corresponds to risks people take without thinking in their everyday life (for example when they make a journey by car rather than by train or drive on an all-purpose road rather than a motorway). These risks are vastly outweighed for the individual by the health benefits and for society by the reduced risk to third parties. The argument, however, is not just that the risks are outweighed. More fundamentally than that, the increased risk of cycling over driving is not large enough for people to be concerned. They accept similar risks unhesitatingly. Indeed the only risk difference large enough to worry about is in the opposite direction – cycling is safer for young male drivers/cyclists.

    Active travel and cycle safety may be the biggest issue but we also have important contributions to the debate on congestion, disability, the impact of streetscape on social support, travel to health services, and many other issues. In the airport debate we believe in an international high speed train network that can confine the need for aviation to flights over oceans and polar ice packs and local links in very remote areas like the Arctic. No transport policy or project can now be regarded as complete if it has neglected its health impact.

    Reproduced, with permission, from the Journal of Transport & Health Vol 1 issue 1 March 2014

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    Transport and Health Study Group

    The Transport and Health Study Group is the principal public health organisation in the transport field, certainly in the UK and probably in Europe.

    We were deeply concerned at the Advertising Standards Association ruling banning a cycling advertisement in which the rider was not wearing a cycle helmet. In our view it is far from clear that cycle helmets ought to be promoted as actively as such a ruling would imply. There is significant professional and scientific controversy on this subject, so much so that the Journal of Transport and Health (a scientific journal which we sponsor for publication by Elsevier) will be devoting an entire issue to the debate in the near future.

    Cycle HelmetsThe first problem is that epidemiological evidence has never succeeded in demonstrating at a population level the benefits that might be expected. This raises in our minds the real possibility that there is some factor which counters the benefits that might be expected from the helmet, possibly a physical factor (such as increased risk of neck damage), possibly a behavioural factor in the cyclist (such as risk compensation) or possibly a behavioural factor in others (there is one study which shows that drivers drive closer to cyclists who are wearing a cycle helmet). There are also good reasons to accept that research on cycle helmet effectiveness was strongly affected by confounding factors, related to social class differences between those who do, or do not, choose to wear a helmet. Whilst this issue remains unresolved there is a basis on which a scientifically well-informed rider could legitimately decide that it was safer not to wear a helmet.

    The second problem is one of proportionality. If the above doubts can be resolved there is indeed a case for wearing a helmet whilst cycling. It is however no stronger than the case for wearing a helmet whilst walking in icy weather, whilst walking when over the age at which balance starts to decline, whilst walking when tired, inebriated or unwell, or whilst driving. Serious head injuries occur in all of these settings. Some might query the equivalence of wearing a helmet whilst cycling or whilst driving by asserting that the cyclist is more vulnerable. However, properly analysed, the statistical risks are indeed equivalent. The cyclist may be less protected but the forces involved in car collisions are greater (indeed rise with the square of the speed). Indeed, driving helmets have been compulsory in motorsport since the 1950’s, yet there have been no moves to promote their use in daily driving. The case for wearing a helmet when playing football is much stronger than the case for wearing a helmet whilst cycling.

    The third problem is the impact that the disproportionate advocacy of cycle helmets has on cycling rates and hence on the diseases of physical inactivity such as heart disease, obesity and diabetes. To advocate helmet-wearing when walking, driving, cycling and playing football would be harmless and would represent one legitimate point of view in the debate about risk-aversion. To pick cycling out of that list is to make it abnormal – to put it in the same category as motorcycling or being on a construction site. Cycling is safe. Urban cycling in England is safer than driving in France. Comparing like journeys cycling is very similar in risk to driving. It is safer than walking. For young male road users it is considerably safer than driving. If there is a very small difference in risk between cycling and driving it is of the same order as choices which people make unthinkingly such as to take a car rather than a train or to drive on an all-purpose road rather than a motorway. And that very small risk is more than offset for the individual by the health benefits (cycling increases life expectancy rather than reducing it) and for society by reduced third party risks (if third party risks are taken into account cycling is considerably safer than driving). Yet the false idea has arisen that cycling is unsafe. And that idea causes serious harm to many people by dissuading them from cycling.

    Of course the fact that something is safe does not mean that it ought not to be made safer. It is indeed perhaps an exaggeration to describe something as safe when it is simply no more dangerous than driving, an activity which has killed more people than both world wars. But to select cycling from a list of activities which would equally benefit from helmet-wearing, and to deploy regulatory activity to cycling uniquely from that list, is to present a harmful false impression of its danger. This harmful false impression will kill people – they will be put off cycling and as a direct consequence will be twice as likely to die of heart disease and much more likely to suffer diabetes.

    The ASA could correct this disproportionate message in either of two ways. It could stop banning advertisements which show cyclists without helmets or it could extend the ban to cover adverts which show people driving or walking without helmets. It should do one or other of these two things.

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    Top line: Psychologists have long recognised the potentially detrimental effect of the commute. Most studies of the commute and stress find that active travel, followed by public transport use are the least stressful modes and that active travel is often reported as a positive experience in terms of stress management.

    Harold Lloyd commuting

    Research suggests that for many people happiness is being able to make the routines of everyday life work, such that positive feelings dominate over negative feelings resulting from daily hassles. Given the importance of the commute for many working age adults the stressfulness or otherwise of this routine behaviour has been the subject of a number of research studies. Across the developed world the results indicate that active travellers tend to be less dissatisfied with their commute,1 if not actually to enjoy the journey. Car commuters find their journey more stressful than other mode users. The main sources of this stress appear to be delays and other road users. Users of public transport also “complain” about delays; however, this results in stress as well as boredom. Walking and cycling journeys are the most relaxing and exciting and therefore seem the most optimum form of travel from an affective perspective.2 Explanatory factors include desirable physical exercise from walking and biking, as well as that short commutes provide a buffer between the work and private spheres. Negative feelings during the work commute increases with the length of the commute. 3

    A US study looked at the commute by car or train in New York.4 Train commuting was reported to be less stressful and created less negative mood than commuting by car. Part of the reason why commuting by car is more stressful than by train is because car drivers experience the commute as requiring more effort and being more unpredictable than train travellers reported for their journeys. Contrary to expectation, however, both train and car modes have similar, relatively high levels of perceived control. Results were found even though both car and train commuters used the commuting mode of their own choice.

    Previous research has also addressed the association between stress and crash involvement among car drivers.5 Research suggests that interventions may need to be developed to increase driver awareness of the dangers of excessive emotional responses to both driving events and daily hassles (e.g. driving fast to „blow off steam‟ after an argument).6 There is, however, little research in the road safety literature which identifies changing travel mode as a way of addressing driver stress.

    1 Paez, A., Whalen, K. 2010 Enjoyment of commute: A comparison of different transportation modes, Transportation Part A: Policy and Practice: 44(7): 537–549.
    2 Gatersleben, B., Uzzle, D. 2007 Affective Appraisals of the Daily Commute. Comparing Perceptions of Drivers, Cyclists, Walkers, and Users of Public Transport, Environment and Behaviour, 39(3): 416-431.
    3 Olsson, et al, 2013 Happiness and Satisfaction with Work Commute, Social Indicators Research, 111:255–263.
    4 Wener, R., Evans, G. 2011 Comparing stress of car & train commuters, Transportation Research Part F, 14: 111-116. 5 Eg Legree, P., Heffner, T., Psotka, J., Martin, D., Medsker, G. 2003 Traffic crash involvement: experiential driving knowledge and stressful contextual antecedents, Journal of Applied Psychology, 88 (1): 15–26.
    6 Rowden, P. et al 2011 The relative impact of work-related stress, life stress and driving environment stress on driving outcomes, Accident Analysis and Prevention, 43(4): 1332–1340.

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    Victim blaming in child pedestrian injuries is a strategy which serves to maintain the economic interests of the dominant groups in society at the expense and suffering of children, particularly those from low income families.

    Whilst cardiovascular disease and cancer are the major causes of death in adults, in childhood, motor traffic inflicted injuries, particularly as pedestrians, are the leading cause of death. For every death approximately ten children are seriously injured. Many of these suffer long term disability. Individualism – ie the responsibility of individuals to take preventive action – constitutes the ideological base of preventive policies. Strategies for the prevention of child pedestrian injuries are, for example, almost entirely aimed at improving child pedestrian behaviour, despite robust evidence that this is likely to be ineffective.

    Roberts and Coggan analysed the processes involved in the aftermath of the death of a 10 year old girl walking home from school.[1] This included the police officer’s report from attendance at the crash scene. At this stage the officer coded his form as “Pedestrian: crossing road heedless of traffic, unattended child”. A week later an engineer from the local highways department attends the site and notes the likely average speed of the motor traffic and the mean traffic flow per minute. From this Roberts and Coggan note that “there was a mean traffic flow at the injury site of 877 vehicles per hour, approximately 15 vehicles every minute. Thus the mean time available for crossing, assuming a steady flow, would have been only four seconds. It is quite likely therefore, that running was a necessary prerequisite for road crossing rather than an indication of impulsiveness”.

    The Coroner’s Inquest comes next. The stated aims of which are to determine the ‘facts’ surrounding the death, primarily for the purpose of reliable record keeping for the State. In considering the case the coroner observed that because of the widespread provision of traffic education in schools the type of erratic traffic behaviour displayed, would be unusual for a 10-year-old. He observed that children are repeatedly told “don’t jaywalk, but (name) may have been doing a little bit of jaywalking”. The verdict returned by the coroner stated: “’I find that (name) died at (place) accidentally, sustained when she ran out into the path of an approaching vehicle without checking that the road was clear of traffic.”

    In this case, a choice was made between the two main contenders for individual responsibility, the driver and child victim. Since the driver’s claim of traveling at 40 kph (within the 50 kph speed limit) was accepted, no negligence was attributed to the driver. That responsibility was located with the victim. Although walking out into the road clearly did result in this child’s death and might appropriately be considered a cause, it was nevertheless only one of a number of causes. ‘Other causes of pedestrian injury which could equally have been chosen for consideration would include poverty, high traffic volumes and high vehicle speeds.’ However, a drawback of the multi-causal approach to causes is that it allows some causes to be singled out for attention above others. This is a choice motivated by ideology in which threats to road transport infrastructure must be resisted in order to protect vested interests which rest on economic expansion.


    [1] Roberts, I., Coggan, C. 1994 Blaming children for child pedestrian injuries, Social Science & Medicine,38(5):749-753.

    essential evidence

    Dr Adrian Davis

    Key evidence from peer-reviewed literature is being used to strengthen the case for current transport policies and practice.

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    The British Cycling Economy

    The full report

    Bradley Wiggins Foundation

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