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Wednesday, 20 March 2013

Positive about health

Recently, I attended the Public Health 2013 Achieving Positive Health Outcomes conference. Aside from the fact that the word positive in a health context is not always, well, positive, (think HIV positive) it was interesting and stimulating to be amongst public health colleagues. In particular, it was good to hear from the determinedly non-pompous head of PHE, Duncan Selbie who talked about ways of working and yes, positive attitudes to colleagues and others.

The purpose of the conference was to introduce local authorities to issues in public health now that, as Roy Lilley so eloquently put it in his blog, it is ‘stuffed up the back passage of the town hall’. So, there was a lot of hard sell from private companies hoping that local authorities would commission them to provide weight management services or active lifestyles at a price. Don’t know why; local authorities are strapped for cash and that lovely ring fenced public health money is not going to stretch to anything other than the most basic, but hopefully effective, public health interventions.

It was not all commercial sell and there was a presentation from the public health team in NHS Wiltshire and NHS South of England on the excellent work they have done on tackling unintended pregnancy in the region. This was through incentivising GPs to train to provide long acting reversible contraception (LARC) thus increasing access to contraception across the region. GPs had their training paid for and additionally, for each implant they are paid £61 (and the same for removal).  All funded by Improving access to contraception monies. Whether that programme will be sustained now that funding is coming to an end remains to be seen. Will GPs continue to provide the service if they are not receiving payment for it?

Ironically, the conference was held at The Brewery Conference Centre, which, when I was training as a nurse a million years ago at nearby Bart’s Hospital, was still a working brewery - dray horses and all - but is now a beautiful conference centre. However, its association with alcohol seemed slightly at odds with the promotion of public health or, as we were regularly reminded, the public’s health – as if we hadn’t thought about that before.

The alcohol link was not direct sponsorship more just an association so I got over it. But coming in the week that it did with minimum pricing for alcohol looking like it was taking a dive, it did make me think. Is alcohol advertising, promotion, branding, its very presence all around us as pernicious as we now consider that associated with smoking?

There was a time, not so very long ago, that tobacco companies sponsored a vast array of sporting events and no one thought anything of it but as smoking has slowly become almost as antisocial as, say, drink driving, is alcohol becoming the same? I don’t think there’s a lobby to ban alcohol completely - it is not quite the killer that smoking is and, let's face it, prohibition was a disaster.

However, there is no doubt that ‘something has to be done’, if only to rein in our enthusiasm for alcohol. Drinking is so easy. It’s easier, in fact, then smoking. It’s always been frowned on at work unlike smoking which was once a part of office life, and those employees who drink at lunchtime are a rarity these days, but buying alcohol and consuming at home is so easy and so cheap, compared to a generation ago.  And culturally, it’s acceptable. Smoking is no longer culturally acceptable. People might at best feel sorry for you if you smoke but they won’t joke and laugh about it and share their smoking stories like they do about drinking.

Studies show that minimum pricing does have an effect on drinking levels in the population with one Canadian study showing that a 10% increase in average minimum price for all alcoholic beverages was associated with an almost 32% reduction in deaths wholly attributable to alcohol. The study by Tim Stockwell, Jinhui Zhao and colleagues showed that there was also a time lag in the impact with fewer deaths from alcohol two or three years after minimum prices were established.

Certainly minimum pricing will not solve all alcohol woes but it might be a positive step towards acknowledging that we may have a problem. And that first step is important in any addiction, whilst a positive attitude is essential in public health.

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