Under water

You will remember when we were all flooded just recently (before the ice age struck). Well, I woke up to the sound of water dripping steadily. Sadly, it was not a burst of enthusiasm on the part of the shower but the bathroom ceiling that was spilling out. I touched the ceiling and realised I was standing under a giant sponge. Fortunately, I have the kind of neighbours who always ‘know somebody’ and they put me in touch with a friendly plumber who advised me to empty the water tank which lurks in the loft just to the side of the giant sponge and to stick a screwdriver into the ceiling to relieve the pressure of any water.

I did this in my best nurse lancing a boil manner (ie turned away in case anything hit me) but nothing gushed out, the water kept dripping and a bit of the ceiling came away, sodden and rotten.  A quick investigation in the narrow roof space (by nice plumber not yours truly – too many spiders) was that there was a leak in the roof that had been there for some years but someone had thoughtfully placed a washing up bowl under the leak and a few towels. As we have been in the house six years this was a bit mind boggling. However, I have been fortunate enough to find someone to repair the roof and a plasterer is due soon (no really) to repair the inside.

It did not escape me that I was lucky enough to fix this problem easily and although emptying a huge hot water tank was enough to make me cry (bad enough when it’s a house full of teenagers emptying it for you but to be pouring it away was criminal) but I knew I could afford to do so. I knew too that the damp built up over the years was fairly minimal and unlikely to have been harmful to our health (although it explains the mould that kept growing in the bathroom). 

Others are not so fortunate and damp is all too often a result of poverty caused by poor housing and a lack of heating. Damp leads to mould which can be associated with a range of breathing problems from wheezing to asthma, coughs as well as serious infections such as meningitis.

Nowhere is this brought home so profoundly as by the tragic story of baby Telan Stone featured in the Guardian in association with Joseph Rowntree Trust. http://www.guardian.co.uk/society/video/2012/nov/19/child-damp-temporary-housing-video

The Stone family lived in a one bedroom flat where the damp was bad enough for there to be fungus growing out of the walls. Whilst no direct connection has been made between the damp and Telan’s death, it is absolutely true that people should not be living in such conditions. The Stone family has since been rehoused. 

Six years ago the charity Shelter produced a report highlighting the impact that bad housing had on children’s health http://england.shelter.org.uk/__data/assets/pdf_file/0009/66429/Chance_of_a_Lifetime.pdf  In the report, Shelter recommended the building of affordable homes, doing more to help those on low incomes to stay in their homes, increasing resources to improve the quality of rented homes – both social and private - and called for a target deadline for overcrowding to be a thing of the past.  

 

All these recommendations were made six years ago and still, judging by the Guardian’s poverty series (http://www.guardian.co.uk/society/poverty) or reports from any number of charities, the problems are the same, if not worse now, with welfare cuts and housing benefit caps destroying an already wobbly infrastructure.

From a position of public health, the answer is mostly obvious. Start upstream. If the beginning is poverty, that is what needs to be addressed. Cutting benefits and dividing the world into deserving and undeserving does not solve the problems, it merely tries to cover them up.

It’s a bit like sticking a washing up bowl under a hole in the roof and hoping that the next occupants won’t notice the leak. Eventually it will cause damp, damage and potentially disaster which might not be put right so easily.

Reference

Marmot M, Wilkinson R, (eds) (2004) Social Determinants of Health, Oxford University Press

Starting upstream

It was the upstream/downstream story, sometimes known as the public health parable, that sold public health to me.  I was familiar, as we all are, with the old adage ‘prevention is better than cure’ but this story really brought  home to me what this meant.There are many versions of the story but it goes something like this:

“Imagine a large river with a high waterfall. At the bottom of the waterfall hundreds of people are working frantically trying to save those who have fallen into the river and have fallen down the waterfall, many of them drowning. As the people along the shore are trying to rescue as many as possible one person looks up and sees people keep falling into the water and tumbling down the waterfall and begins to run to where they are falling in. One of other rescuers shouts, "Where are you going? There are so many people that need help here." To which the man replied, "I'm going upstream to find out why so many people are falling into the river.”

It just makes perfect sense and so began my passion for public health. Why spend the largest proportion of health service money on building and staffing vast hospitals in order to treat sick people when preventing ill health is so much cheaper for the state and better for the individual? 

But, advances in medical science are so much sexier than persuading people to stop smoking, drink less, eat sensibly and have sex safely. And, as my grandfather (himself a doctor) used to say: "Commonsense is not common".

So this blog will aim to share with you some of my passion for public health. It will explore some of the stories in the headlines and aim to provide context and background. It will link to those who know better and more but will generally be a place for enthusiasts to comment and share. Please do join in.