THE FINAL WORD In this issue ‘ ’ > Camila Batmanghelidjh on the war against futility Josie Gibson won TV reality show Big Brother in > Why nekNominate is a sign of the times 2010. Following a series of comments and > Should we pay mums to breastfeed? photographs in the media about her weight, she The magazine of the UK Faculty of Public Health began to exercise more and eat sugar less www.fph.org.uk

March 2014

FOR readers who don’t know who I am, sugar trap. A scary thought is that storage of fat. I went on a TV show about three years ago currently in the UK obesity rates have Sugar was my addiction and the thing

and have been one of the lucky ones, as almost quadrupled in the past 25 years, that set me free was educating myself the show has given me a successful career and this rise has been accompanied by on diet and exercise. I found that after in doing what I love: helping people to lose a rise in sugar intake. Recent reports about 21 days of eating natural foods

weight and get fit. I have struggled with and kicking the habit of sugar my mood my weight from the age of six, and it took swings and depression disappeared, and me 20 years to find the answer. This was one of the I had more energy than I had felt for a My key problem was the sheer amount long time. I really feel sorry for people of sugar I was consuming without even hardest achievements ‘ these days: it’s nearly impossible to have knowing it. What I thought was healthy of my life, and now I a healthy diet with the amount of food (white bread, tinned foods and low-fat want to make sure products that we wrongly deem to be ready meals) turned out, when I read the other people don’t good for us stacked in our shopping ingredients, to be full of sugar. By ‘ aisles. I am so glad we are raising identifying sugar and processed ingredients fall into the same awareness of the growing sugar epidemic in common foods and selecting healthy, sugar trap as I feel obesity has taken some of my natural ingredients instead, I was able to best years away from me. I am now an lose weight without dieting. I went from advancedBurn nutrition advisor and a personal nearly 17 stone to my current size 10, and have also shown that fizzy drinks can trainer [Josie’s latest DVD, The 21 Day Fat I feel better than ever. contain up to nine teaspoons of sugar, , is out now] and my mission in life This was one of the hardest and biggest which is more than enough to spike a rise is to help other people beat their addiction achievements of my life, and now I’ve in blood glucose and consequently insulin. to sugar. found the answer I want to make sure This can then lead to type 2 diabetes and other people don’t fall into the same other health concerns as well as excess Josie Gibson

Editorial board Address: Information Andy Beckingham Faculty of Public Health Stella Botchway 4 St Andrews Place Matthew Day London ISSN – 2043-6580 David Dickinson NW1 4LB Jenny Hacker www.fph.org.uk Editor in chief Rachel Johns Alan Maryon-Davis Frances MacGuire Submissions Helen McAuslane If you have an idea for an article or special Managing editors Sally Millership feature, please submit a 50-word proposal Lindsey Stewart and Mag Connolly Thara Raj and suggested authors to: [email protected] Sowing the seeds of the future Leonora Weil The proposed subject of the special feature Commissioning editor in the September edition is The General Why children’s wellbeing today means better health tomorrow Liz Skinner Contact us: Election. Email: [email protected] Production editor Health Policy, Media & PR: 0203 696 1452 Richard Allen Education: 0203 696 1451 All articles are the opinion of the Professional Affairs: 0203 696 1453 authors and not Public Health Today is distributed to Business & Corporate Services: those of the Faculty over 3,300 public health specialists. To 0203 696 1455 of Public Health as advertise please contact Richard Allen an organisation at [email protected] Public Health Today FROM THE PRESIDENT UP FRONT The magazine of the UK Faculty of Public Health www.fph.org.uk swallowing the head of a young chick and Welcome Web drinking stubbing out a cigarette on his tongue in News in brief an online video, interspersed with heavy March 2014 HE role of president of the Faculty craze is ‘tip of drinking. Another 19-year-old was reported of Public Health (FPH) is very much to have downed three bottles of spirits

T like a piece of string: it’s as much an iceberg’ before being found by his parents as you want to make of it. Notionally unconscious on the sofa covered in vomit. Significant drop in measles cases two days a week has felt very much in It’s the combination of heavy drinking There was a sharp fall in the number of Contents excess of the European working time and daring others to do the same on the cases of measles in England at the end of

directive, but it is very satisfying. I have internet that makes nekNominate 2013, figures from Public Health England reported in the ebulletin on my first THE Faculty of Public Health (FPH) has been especially dangerous. “This has created a show. Twenty four people were infected round of visits to all parts of the UK prominent in warning about nekNominate, between October and December, in Up Front 3 which is nearing its conclusion. The a web-based drinking challenge that has contrast to the hundreds of cases each caused at least five deaths among young ‘ month at the beginning of the year. The good news is that the troops still have Social media and an appetite for changing the world and people as we went to press. FPH alcohol fall was put down to efforts to get more that our registrars coming through are spokesman Mark Bellis was widely quoted peer pressure are children vaccinated with the MMR jab. Interview with Camila of Physicians (RCP) of London of a an inspiration. The bad news is that and told BBC TV that the harm caused by Batmanghelidjh 4 working party on the impact of air combined with a Andrew Lansley’s reorganisation of the pollution. I am involved as a Council the drinking ‘game’ was probably the tip substance that makes Hair straighteners top child burns list of an iceberg. Professor Bellis was able to Hot mugs and hair straighteners are the NHS has had a devastating effect on Adviser of the RCP. Many people still think people very morale in some places and that a that air pollution in the UK disappeared use the media interest to broadcast the ‘ leading causes of childhood scalds and proportion of local authorities either public health message on the harm caused susceptible burns, and one-year-olds are at greatest Special Feature – Child Health 6 with the clean air acts of the 1950s, but don’t ‘get’ public health or appear to be this could not be further from the truth. by UK alcohol consumption. Speaking on risk, data reveals. Professor Alison Mary wilfully neglecting their duty of BBC Breakfast, he pointed out that around Kemp from Cardiff University and Playing politics 6 This working party under Stephen Holgate stewardship. There has been significant should make a significant contribution to one in five of all deaths in adults under 45 very dangerous cultural environment,” colleagues looked at admissions to three Government failing to protect children attrition of experienced staff, and there public health. For more information was linked to alcohol. Professor Bellis told the Telegraph. “A few leading burns units and five emergency from food advertising 7 have also been casualties. At the recent contact [email protected] NekNominate is a recent craze, thought things come together here, with social departments in the UK. meeting of the Academy of Medical I assumed the chairmanship of the FPH to have originated in Australia. People media and a real risk of peer pressure, Healthy children mean a healthy future 7 Royal Colleges, Clare Gerada reported International Committee in January and video themselves drinking to extremes and especially combined with a substance that Obese people in Wales ‘told to gain weight’ challenge others, usually ‘friends’, to do Life-saving treatments are being denied to Debate: Is breast necessarily best? 8 on the service she runs in London for together with our Chief Executive, David makes people very susceptible.” That gives sick and stressed doctors. She was clear Allen, am considering how best to put it the same. Some add other challenges or public health professionals a platform to obese people in Wales, a leading group of Stairway to haven 9 that our specialty has not been exempt on a strategic basis that is congruent video themselves taking stupid risks. The remind everyone – not just the very surgeons has said. The British Obesity and from the significant increase in those with the overall FPH strategy. I will report Daily Telegraph reported a youth young – of the dangers of abusing alcohol. Metabolic Surgery Society said morbidly Third of young people suffer seeking help. We all have a duty of care on this further in due course. Meanwhile obese people had been told to gain weight online abuse 10 towards each other, and I trust that David and the staff at St Andrews Place to qualify for bariatric surgery. It voiced its concerns to the Welsh Government’s Spare the rod and spare the child 10 following the “transition”, the legacy of have been running a series of strategy harm will not be overlooked by those workshops which will give us a refreshed Health and Social Care Committee. Breaking the cycle 11 with a responsibility for human resources. draft for consideration at our annual child would have inhaled in a smoky pub. ‘Pocket optician’ trialled in Kenyan schools On some of my regional visits I have conference in Manchester in July. Protect children “We very much hope that public support They matter to us all 12 A modified smartphone is to be used by been taken aback by the numbers of David Allen and I had an excellent will help this law to be enforced, just as teachers in Kenya as part of trial to catch Going for gold with sport vacancies which seem to exist and the meeting with Ian Cumming, Chief from smoke in the smoking ban in public places has been. pupils’ eye disease. The same kit used on safeguarding 13 apparent dearth of timely information Executive of Health Education England, We need more of this evidence-based older people had had promising results and about them. Please keep me informed as and I am happy to report that Ian is a cars, say MPs approach to policy so that we protect and Putting the D back into child led to more than 1,000 people receiving to what is happening on the ground, so public health enthusiast. We used to save lives.” development 13 treatment, according to the team behind that we can ensure a good flow of work together at Mersey Regional Health Some attitudes take time to change, but information. Serious oddities and issues the project at the London School of Making herd immunity herd Authority in the 1980s, so perhaps I can a majority of legislators in the Commons about terms and conditions continue to Hygiene and Tropical Medicine. mentality 14 claim some early influence! He particularly have accepted the case for a ban. FPH will surface. They are a legitimate matter of wishes to see an improvement in public A VOTE has been passed in Parliament in keep an eye on the parliamentary Ban on ‘no helmet’ advert under review concern for FPH and are not exclusively a health careers awareness from age 13, favour of banning smoking in cars when timetable to make sure the ban gets into A ruling against a safe-cycling advert which trades union issue. Strong, effective including awareness of the different children are present. The vote on law as soon as possible. Can of worms 14 teams depend on having the best people degree routes which can culminate in amending the Children and Families Bill showed a rider without a helmet has been withdrawn while authorities review their with the right complementary skill sets in public health. This is, of course, essential was passed by 376 votes to 107. The David Dickinson each public health directorate. Postcode for the ongoing development and amendment opens the way to a future decision. The advert is part of a campaign public health is unacceptable. support of multidisciplinary public health. change in the law, making it a criminal by Cycling Scotland. The Advertising Books & Publications 15 January saw some important meetings. A lot of ground is covered in this issue offence to fail to prevent smoking in a Standards Authority objected on “health Many of you will have come across the of Public Health Today. There is growing privately owned vehicle when children are and safety” grounds but has now North of England European Union Health concern about the state of the nation’s present. The strength of support given to withdrawn its “potentially flawed” ruling Partnership which has done good work children compared to other countries. The the motion makes a legal ban much more while an independent review takes place. Endnotes 16 over many years from its Brussels and launching of the British Association for likely, and government sources have since England bases. Each time there is a Child and Adolescent Public Health, which said that legislation will follow. WHO: Daily sugar intake should be halved reorganisation there has to be a new has grown out of a Special Interest Group, John Middleton, FPH’s Vice President for People will be advised to halve the amount scramble for funding if the programme is most welcome. I would encourage Policy, welcomed the result: “We owe our of sugar in their diet under World Health Noticeboard 19 of Brussels visits and support for those who feel passionately about this thanks to all those MPs who voted to Organization (WHO) guidance. The programme bids is to continue. Hopefully, issue to join up and get involved. The protect children’s health. Passive smoking recommended sugar intake will stay at arrangements will soon be in place to case has to be made that the economic results in around 400 sudden infant deaths below 10% of total calorie intake a day, ensure that this resource continues to be future of the UK depends on us not a year. Adults can choose how they travel, but with 5% the target. UK campaigners The Final Word 20 available. For details contact Chris Birt at wasting our most precious assets. but children can’t. A single cigarette in a said it was a “tragedy” that WHO had [email protected]. January car, even if a window is half-open, creates taken 10 years to think about changing saw the inauguration by the Royal College John Ashton two-thirds of the second-hand smoke a its advice.

MARCH 2014 3 INTERVIEW INTERVIEW

Camila Batmanghelidjh is the founder and director of Kids Company and has been a psychotherapist for more than 20 years. In her early twenties she founded her first charity, Place2Be. She told Public Health Today that we have to rethink how we provide physical and mental healthcare to children with behaviour problems.

`Futility is our biggest enemy’

Deliver emotional contact, says Batmanghelidjh

What aspects of your work do you enjoy most? What are the common misconceptions about the way our patients are telling us are needed? I think the time has Spending time with the children and young people. I have such a children Kids Company works with? ‘ come to make philosophy of care top of the list of political deep love for them. There is an immediate intimacy from getting Generally people don’t get close to these kids to find out what’s priorities. Politicians rarely talk about their agenda for child to the point. I love those conversations. I put structures in place happened to them. Our job is to bridge that divide. That’s why These kids are heroic. To protection. It’s because Britain does care under the carpet. because I wanted workers to have meaningful conversations and we’ve brought in scientists and researchers to look at what was be that traumatised and Care is the wellbeing of a human being, and it’s not divided then problem solve every aspect of a child’s life, there and then. happening to these children’s brains. Results are showing between social care and healthcare. How do you want to do public The child deserves that help, and we apologise if the resources are significant structural and functional changes that result in poor violated and to get up health? At its source or at an after-event that has suppressed the not there. It’s so important to deliver the solution and apology social behaviours. symptoms of poor care? simultaneously. every morning is an The children we work with have complex problems. A third of Is that something that can be reversed? ‘ incredible act of courage How can FPH’s members support this model of care? our kids under 14 don’t have a bed. One in four don’t have any This model of intensive re-parenting works. A medical paper is Come and visit us, and we’ll show you how it works. We help chairs or tables. Just under 20% don’t have underpants, and 85% about to be published which shows that after nine months of 3,600 children, people and vulnerable adults through a tiered rely on us for their evening meal. They are usually sexually and intensive care by Kids Company, there were dramatic, positive, system of intervention. Also, you could run a pilot, assess the physically abused by their immediate carers. functional changes in the most criminally disturbed group of 11-17 outcomes and do a comparative study. I’m all for rigorous University College London carried out research with us which year olds. delivery of emotional contact backed up by systems. research. Futility is our biggest enemy and justifies people to do showed that one in five of the children they had assessed had We have to rethink how we provide physical and mental There’s something ingrained in the British psyche where nothing. been shot at or stabbed, and 50% had witnessed shootings and healthcare to these kids. At the moment, the model is based emotionality equals chaos. Emotions are logical: you just have to stabbings in the previous year. The research found that the around appointments. The assumption is that an adult will take the work out what the logic is. You need to operate as a caregiver or Where do you want to see the care of vulnerable neuronal pathways of these children were mimicking war veterans child to the appointment. Yet 80% of these children are being clinician through your emotions to function as a healer. You need children and young people in 10 years’ time? with post-traumatic stress disorder. The kids tell me they are abused by their immediate family who won’t want the psychiatrist to back that up with robust and systemic narratives. We’ve ended Top of the agenda, and for politicians to stop passing judgements soldiers. Their war is growing up in Britain. to find out what’s going on. up with a culture of delivering care through systems. That’s where and take responsibility. Parents are responsible for coming up with There isn’t enough help because society has ended up passing A good drop-in model is better, where you almost recreate a we are going wrong. It ends up burning out workers. solutions. If they are not functioning, the state needs to step in, moral judgement. Decision-makers attribute moral flaws to kids family home, but parental figures are the doctor, nurse or artist. Our London School of Economics research into our front-line provide loving care and honour the childhood contract so that it is and young people who are said to have chosen to be criminals or Some of our centres are open from 9am to 10pm. So the staff came with 92-97% wellbeing rates. Our staff stress levels responsible for the wellbeing of a child. If you break that contract, join gangs. This notion of choice means that often politicians don’t psychiatrist plays basketball with the children and gets to know came out within a normal range. Regulating and nurturing our be prepared as a society to pay the price for it. create a care infrastructure to protect these kids. Health delivery is them better. That makes it much more likely that the psychiatrist staff, and making sure they have the right resources, is very determined by a political narrative. [can] do a formal assessment. The child will be much more honest. important. Is there anything that keeps you awake at night? Health providers are not providing reparative programmes for It’s so much more efficient. The one thing I obsess about is fundraising. I have to raise £23 children and young people who are, in effect, as traumatised as Because it is a solution-focused approach, rooted in the What’s the best way for public health professionals to million a year. I’m very focused when I need to be – but my head is soldiers. These kids are heroic. I believe their courage and heroism community, the children have a sense of security. You can no tackle the social determinants of health? very empty and peaceful. I love swimming. I love compassion for are not acknowledged enough. To be that traumatised and longer divide physical and emotional health. We have to change The clients and the community hold the expertise. It’s a question of compassion’s sake. violated and to get up every morning is an incredible act of our public health models to create more resilience against practical being curious and extracting the philosophy of practice from the courage. That’s why I like working with them. and emotional environmental adversity. Robust care is about the clients themselves. Do we have the guts to rewrite services in the Interview by Liz Skinner

4 PUBLIC HEALTH TODAY MARCH 2014 5 SPECIAL FEATURE: CHILD HEALTH SPECIAL FEATURE: CHILD HEALTH Government is failing Healthy children will mean a to protect children healthy future from food advertising

WE SHOULD be profoundly ashamed of our child mortality rates, says England’s Chief THIS month, the British Heart Foundation is Medical Officer, Dame Sally Davies. Child working with a group of concerned poverty is rising, and inequalities are growing charities and health experts, including the ever wider. Universal child benefit has been Faculty of Public Health, to call on the abolished, and the lives of thousands of Government to take action on junk food young people are being blighted by lack of marketing to children. education, training and employment. Little The Government is failing to protect wonder that UNICEF ranks the UK low in children from advertising of processed many measures of health and wellbeing. foods and drinks high in fat, salt and At the British Association for Child and sugar (HFSS). Children are a vulnerable Adolescent Public Health (BACAPH) launch group and should not be directly targeted in October, Sir Michael Marmot set a by advertising for unhealthy food and challenge: we are failing children on a grand drink products. This practice is scale. What are we going to do about it? compromising parents’ efforts to keep their There is unprecedented turmoil in the NHS kids healthy in the context of a looming and local authorities, with reorganisations Playing politics obesity crisis where around one in three and privatisation. Action is more urgent children in the UK are already overweight than ever. We need our combined expertise or obese. and voices to improve the health and Improvements in child health through legislation and industry practice Children are constantly exposed to junk wellbeing of children and young people. are being undermined by cuts in services, says Alan Maryon-Davis food marketing: on TV, on radio, on the BACAPH has an ambitious aim: to create internet, in emails, social media and text a blueprint to meet the health and messages, at the cinema, in comics and children’s programming which are intended wellbeing needs of children and young magazines, in supermarkets, on food to reduce the number of these adverts that people – now and in the future. Way We Feed Babies Has Come to Define packaging, and, for some, even at school. children see. However, this is a small BACAPH will work through three themes: or close altogether. Child and Adolescent Californian author of Bottled Up: How the measure that has not had the desired n Motherhood, and Why It Shouldn’t Research shows that food promotions Policy: promoting the development and Mental Health Services are similarly under can influence children’s behaviour in a impact – children’s peak TV viewing time is implementation of evidence- and rights- threat across the country. GP services are , says no. number of ways including their now 8pm-9pm and children are spending based child public health programmes. stretched to breaking point, and A&E We have Thara Raj on the perennial preferences, purchase behaviour and more time online. n Advocacy: encouraging participation of

departments are packed with the overspill. effort to improve immunisation coverage consumption. Children as young as 18 The Government needs go further to children and young people speaking on The benefits system is in turmoil and the and the challenges in introducing a months can recognise brands, and children protect children: UK rules need to be important issues that matter to UK children number of young families facing real universal flu vaccine for children. There’s as young as three have been shown to brought up to date so that they apply to and families.

hardship has soared. Food banks are in also Laura Chu exposing some of the prefer branded, over identical unbranded where and when children are actually n Knowledge: promoting learning that huge demand. Pawn shops, discount stores wicked tricks the food industry uses to food. Marketing therefore plays a watching and consuming media. This is brings new science to long-standing and pay-day lenders are booming. It’s a market its not-so-healthy products to the significant role in influencing children’s clearly a public health issue that needs questions and providing training to gain the nation’s youth. Plus Martin Schweiger on dietary choices. attention. You can support our campaign skills, competencies and insights to meet AS YOU might expect, in the world of ‘ trafficked children and the failures of the Internationally, there are a handful of calling for a ban on adverts for unhealthy the diverse and growing challenges we children’s public health, it’s all snakes The Government’s system to offer child-friendly support, examples of governments using legislation food and drink products before 9pm on TV face in child and adolescent public health. and ladders. austerity programme Emma-Jane Cross on the insidious dangers to try and tackle this issue. In Canada, the and for stricter rules to apply to online Please join us! We need you – whatever First the ladders. Westminster MPs voted of ‘cyberbullying’, Rachel Hodkin on the advertising to children by signing the is doing real damage province of Quebec has banned all your professional background. We hope to by a thumping 3:1 majority to bring in a many harms from corporal punishment and broadcast advertising targeted at children petition at www.bhf.org.uk/junkfood. offer you an indispensable resource. ban on smoking in cars with a child on to the support system Campbell Bell on safeguarding in sport. under the age of 13, preventing any More can also be done locally to ensure Our website (www.bacaph.org.uk) board, and No 10 said it would be law ‘ for needy children Professor Dame Sally Davies, England’s messaging designed to promote goods, that environments where children gather provides a doorway to a wide selection of before the 2015 election. The stalled issue Chief Medical Officer, dedicated her latest services or an organisation. In Sweden, all or go to get active are free of advertising resources from all four nations of the UK of standardised packaging of cigarettes, an annual report to the health and wellbeing broadcast advertising aimed at children for HFSS products. Health specialists and beyond: policy documents, papers, important deterrent for young people, has grim picture getting grimmer by the day. ofDeserve children. Better: Laura Prevention Weil, Jason Pays Strelitz and under 12 has been banned since 1991. working locally can help by supporting reports, data sources, training events and been revived with a strong indication that Against this broad backdrop we have Claire Lemer look back at Our Children The rationale behind this is based on the local schools, youth and leisure centres, conferences, and soon a members-only it too will soon be mandated. A unified invited a selection of contributors to focus and highlight principle that advertising should be easily and sporting or cultural events to ensure forum where we can share ideas, insights traffic-light food-labelling scheme, crucial on a range of specific public health some of the ways in which its 24 key distinguishable from other media content that these settings aren’t marketing HFSS experience and advice. in the battle against child obesity, has been challenges in the sphere of children’s and recommendations are being taken forward. and that the audience must be able to food and drinks to children. We can work together to make the UK grudgingly accepted on a voluntary basis young people’s wellbeing. And finally, Ingrid Wolfe tells us about the understand its purpose. If you would like to be involved in the the best place in the world in which to by most of the food industry. Our Big Debate is on breastfeeding, and rationale for the recent launch of the British The case for restricting advertising for campaign, please get in touch with us by grow up. But now the snakes. The Government’s in particular whether providing financial Association for Child and Adolescent Public unhealthy foods and drinks to children has emailing [email protected]. austerity programme is doing real damage incentives for mums to breastfeed is a Health and invites us all to join the cause. already been accepted by the UK Ingrid Wolfe to the support system for children and good or bad idea. Clare Relton of Sheffield government. There are rules in place Laura Chu Co-Chair young people in need. Dozens of children’s University, who is doing a study on this hot Alan Maryon-Davis banning unhealthy food and drink Advocacy Officer British Association for Child and centres have had to cut back their activities issue, says yes, maybe. Suzanne Barston, Editor in Chief advertisements on television during British Heart Foundation Adolescent Public Health

6 PUBLIC HEALTH TODAY MARCH 2014 7 SPECIAL FEATURE: CHILD HEALTH SPECIAL FEATURE: CHILD HEALTH

DEBATE: Is breast necessarily best? Mothers in Sheffield are being offered £200 to breastfeed. Clare Relton defends the scheme, while Suzanne Barston says it won’t work

In our NOurishing Start for Health and deliverability of the NOSH scheme in UK rates are (NOSH) study, we are working closely with three local areas. If this goes well, we will local stakeholders in infant feeding (mums, test its cost effectiveness by comparing among lowest partners, midwives, health visitors and neighbourhoods which offer the NOSH breastfeeding support workers and scheme with those where the scheme is in the world commissioners) in developing and testing not offered. the feasibility of the NOSH scheme. While We are aware of the controversial nature BREASTFEEDING is a powerful tool in the designing the scheme, we also looked of the intervention, the sensitivities prevention of disease and the promotion of closely at what was offered by other health surrounding breastfeeding and the taboo health in both mums and babies. The behaviour-change schemes. We found only nature of breastfeeding in some areas, World Health Organization and all four UK often reinforced by infant formula departments of health recommend that all advertising. babies are breastfed exclusively up to the Other countries have taken more radical age of six months, yet only 2% of babies steps to improve their breastfeeding rates. are. Despite a wide range of evidence- For example, in some Nordic countries based policies being implemented, infant formula is only available on GP breastfeeding rates in the UK remain YES prescription. Earlier this year, the United stubbornly low and are among the lowest Arab Emirates passed a law that all babies worldwide. one breastfeeding financial-incentive had to be breastfed until the age of two. Financial disincentives are widely and scheme, in Quebec, Canada, where mums New methods are needed if the UK is to effectively applied in taxes on harmful were given $55 per month to breastfeed improve its breastfeeding rates. We are products, such as alcohol and tobacco. until their baby was one year old. studying one potential method. The results Stairway to haven Mums on benefits are incentivised to eat Stairway to haven So far we have found that, locally, there of our feasibility stage will be out this fruit and veg with Healthy Start vouchers. is broad acceptance of the idea of financial summer. Though incentives to stop smoking during incentives for breastfeeding from Even when child asylum seekers manage to avoid the clutches of traffickers, pregnancy are being tested, the impact of healthcare providers and women in Dr Clare Relton offering financial incentives to breastfeed is neighbourhoods with low breastfeeding Senior Research Fellow the system in the UK is not child friendly, says Martin Schweiger an unexplored area. rates. We are now testing the acceptability University of Sheffield

THERE is a lot we don’t know about child and deal with professionals including year to go before the next General Election asylum seekers entering the United lawyers, Home Office officials and social it is likely that all aspects of immigration biological capabilities? commit time and energy. But success is Kingdom in 2014. The number of people workers. Children damaged today will be and asylum seeking will be contentious Not all babies Critics call this pilot study “bribery”; also reliant on a flawed system that arriving who are, or claim to be, under 16 tomorrow’s damaged adults. and used for political point scoring. its defenders allude to similar mistakes ominous health warnings with is somewhere between 1,000 and 3,000 The distribution of asylum seekers is not Public health objectives need to be are born to be programmes for encouraging weight loss practical support, and, when things per year. The limited data available is based even across the UK. Ports of entry, reaffirmed in relation to child asylum

and smoking cessation. But unlike ridding don’t work out, families are often left on those who have claimed asylum, but particularly Dover, are associated with seekers, preferably as part of ongoing breastfed... oneself of unwanted pounds or nicotine floundering with a dearth of many never do so. Some arrive with other higher asylum entry levels than other areas. discussion among all who practise public addiction, successful breastfeeding information on safe formula feeding. family members, but many vulnerable Areas in which particular nationalities have health. Reductions in morbidity and

SOME are born tongue-tied, early, sick requires the physical and emotional Improper preparation and sanitisation young people arrive alone. It is thought previously arrived are also those areas that mortality need to be mirrored by positive or jaundiced and need extra help cooperation of two individuals – the can cause serious illness; overfeeding that an increasing proportion of those who attract the next set of arrivals. There are gains in physical, mental and social health. learning to eat. And that’s not factoring baby and the mother. In a recent study has been correlated with future obesity. apparently arrive alone are being trafficked Approaches that can be taken include: in maternal difficulties such as of 2,946 women by Wagner et al, the Ignoring the reality of formula feeding to work as cheap labour or in the sex n Seeking and sharing relevant data insufficient glandular tissue, medications main reasons for quitting breastfeeding is the public health equivalent of industry. An increasing ‘ n Active advocacy contraindicated for breastfeeding or handing someone an umbrella in the Traffickers are becoming very proportion of those n Speaking up when wrong messages are postpartum depression. midst of a hurricane. Denying the sophisticated in their techniques. Not pushed out Policymakers and advocates cling physiological and emotional surprisingly, there is no good data because who arrive alone are n Identifying, supporting and sharing stubbornly to the belief that if women impediments to breastfeeding is like traffickers do not submit reports on their being trafficked to models of good practice. were convinced more fully of taking away the umbrella altogether. criminal activities. It is probable that a child ‘ work as cheap labour The Scottish Guardianship Service, for breastfeeding’s value – whether the value Rewarding nursing mums with 200 newly arrived in the UK with a mobile or in the sex industry example, allocates guardians to child is intrinsic (the promise of better health NO quid won’t create a ‘breastfeeding phone, no papers or simply a telephone asylum seekers to provide support and outcomes) or extrinsic (status or financial culture’, it won’t fix a bad latch, and it number committed to memory is being guidance during the immigration and reward) – they would be more likely to included breast pain, latching issues and won’t help babies be fed safely when trafficked. These children are very complex arrangements between local welfare process. This scheme is resource- meet breastfeeding recommendations. fears about insufficient milk supply. breastfeeding isn’t possible. What it will vulnerable to exploitation. authorities, the Home Office and some intensive but, if the current three-year pilot The Sheffield scheme is reportedly an Very few mentioned societal pressures do is create a culture that celebrates Even when children are brought to the housing providers that can mean isolated project is successful, could point the way attempt to counteract societal forces in to bottle feed and not one complained those blessed with cooperative biology attention of local authorities, the asylum people becoming more isolated as they are to partially mitigating the human cost of a low-income area where breasts are that she would have succeeded if and better circumstances and abandons system is not child friendly. Barriers of moved to accommodation remote from children fleeing their homes for a new life overly sexualized and bottle-feeding is someone had only awarded her a those without. language and culture are compounded by those with common background or in the UK. the norm – but then why not reward grocery gift card for her hard work. the lack of resources to respond to the language. husbands, grandparents and employers Breastfeeding problems are often Suzanne Barston needs of child asylum seekers. It can be The issue of child asylum seekers is Martin Schweiger for supporting breastfeeding, instead of fixable, given the right combination of Journalist, author and maternal extremely difficult for traumatised young topical. The imminent arrival of vulnerable Consultant in Communicable Disease putting a price on a woman’s individual expert care and a mother’s ability to health advocate people who find themselves alone in a people displaced by the war in Syria will Control strange culture to navigate its complexities inevitably include children. With barely a Public Health England

8 PUBLIC HEALTH TODAY MARCH 2014 9 SPECIAL FEATURE: CHILD HEALTH SPECIAL FEATURE: CHILD HEALTH By sparing the rod you can save the child

OFFICIAL inquiries are regularly held into child protection, early years intervention and antisocial behaviour. There is much hand- wringing about dysfunctional parenting and our ‘broken society’. Evidence-led measures of prevention are always identified as crucial. But there is one measure of prevention that is never mentioned: ending the physical punishment of children. The silence on the topic is extraordinary given the mountain of evidence showing clear links between ‘ordinary’ physical punishment (as Third of young people distinguished from ‘abusive’ punishment)

and negative outcomes such as aggressive behaviour, impaired cognitive development, suffer online abuse damaged family relationships, domestic

violence, child abuse, criminality and poor mental and physical health in adult life. Breaking the cycle In 2002 a meta-analysis was published in IN THE past six months, several cases ‘ the US of 88 studies which examined lawful Multisystemic therapy tries to engage all the systems in which young people of cyberbullying that have resulted in Many of the young corporal punishment by parents. This found suicide have hit the headlines. Sadly, significant associations with 10 undesirable displaying antisocial behaviour are embedded, writes Jennifer McAuslane cyberbullying is not a new problem. When people who came to “behaviours or experiences” (the eleventh, BeatBullying launched its online support us for help had “immediate compliance”, had mixed results service in 2009, we found that more than broader mental and its desirability was seen as questionable). one in three young people had been health issues A handful of academics challenged the CONDUCT disorder is a public health issue, which young people are embedded (family, by intervening on these issues in victims of online abuse. We also analysed ‘ meta-analysis. They alleged that factors such and the social costs of conduct and school, peer and neighbourhood). Thus adolescence are significant. Estimates data from 2000-2008 and found that as as socioeconomic status, parental warmth, behaviour problems cannot be overstated. therapists work hard to engage all of these suggest that a quarter to a half of mental many as 44% of suicides committed by minority cultural norms or the child’s Poor educational outcomes and an increased systems and involve them in the treatment health problems in adults could be averted young people in the UK are linked at least Warwick-Edinburgh Mental Wellbeing individual pathology might explain the likelihood of becoming involved in the process. with timely and effective interventions in

in part to bullying. Scale, we have also seen significant results. More studies were conducted to criminal justice system at a young age are Therapists see families for several hours childhood and adolescence. Additionally, Bullying not only makes daily life improvements in clients’ wellbeing. Young address these points, and a number of large- the tip of the iceberg. Clear links have each week and are available to them 24 the cost of violence to health services in intolerable for many children, but also people tell us that accessing support online scale international and longitudinal studies been identified between severe childhood hours a day, seven days a week. Treatment emergency admissions and medical care

affects how they develop in the longer is less intimidating than doing so face-to- included physical punishment in their remit. behavioural disorders, adult psychiatric typically lasts three to five months. MST uses has been estimated at £2.5 billion per year term. In the past five years, we’ve face, and they also like the fact that the Over and over again the same conclusion disorders and violent behaviour in later life. research-based techniques such as which could be substantially reduced by supported hundreds of thousands of service is accessible outside normal was reached: smacking was both an Working predominantly in the family behavioural parenting interventions, intervening early in life. children and teenagers with the help of working hours. ineffective form of discipline and posed risks home, multisystemic (MST) therapists The National Institute for Health and our community of online volunteers (both Perhaps, most importantly, we believe in to children’s wellbeing and development. establish a rapport with family members to ‘ Care Excellence guidelines on conduct young people and adults) and qualified the importance of early intervention. Our Meanwhile research conducted in encourage them to be open about their I think it was change disorder published in 2013 point to MST as counsellors. Being bullied can have a model eases the pressure on local countries that had outlawed smacking found child’s problem behaviours. These might in me that brought an effective intervention for this devastating impact on young people’s authorities, saving much-needed money no adverse consequences (such as increased include: population. Many of our families agree: lives. For many it can result in anxiety, and resources. We are currently prosecutions of parents) and also that n Truancy and academic problems about changes in “I think it was the change in me that eating disorders, depression, self-harm establishing the service with clinical violence to children at all levels of severity n Aggressive behaviour (violence, fighting, him, and he hasn’t brought about changes in him, and he and, in severe cases, suicide. What commissioning groups, public health decreased more rapidly in banning countries. property destruction) offended since hasn’t offended since. So, instead of n ‘ quickly became clear was that many of commissioners, schools and communities So why doesn’t the Government leap at Criminal behaviour having an angry mum who pushed him the young people who came to us for as a cost-effective and reliable way to such an evidence-led and low-cost n Drug and alcohol problems out of the house, because I’ve changed it help had broader mental health issues, reach vulnerable young people. As cuts to preventive measure? The short answer is n Running away. cognitive behavioural therapy and structural has given him the space to think about which were often exacerbated or even child and adolescent mental health services politics. A majority of the general public do These reflections from parents about how and strategic family therapy to inform what he wants.” (Parent) caused by the bullying that they were make waiting lists for traditional face-to- not support a ban, and the victims they felt at the start of their treatment with interventions that are tailored to each family. “I listen to my mum more. I’m closer. We experiencing. face counselling longer, we anticipate that themselves do not have the vote. The anti- a MST team are typical of what a therapist The effectiveness of MST has been talk a lot more. My mum’s more happy To meet this demand, we launched demand for this innovative service can smacking campaign focuses on children’s might hear: “I was scared that if I put in demonstrated repeatedly over more than when I speak to her because she used to MindFull, a children’s mental health charity. only grow. human rights and the impact smacking has sanctions, [my son] would be violent toward 30 years of research involving more than be grumpy. We go out a lot more to places Based on a similar model of flexible, online on child protection. It is time for the public me” or “It was really bad. Every minute it’s 7,000 families. In the UK, MST is part of a together. MST actually helps you build up support, in just six months we have already Emma-Jane Cross health case to be strongly advocated too. phone calls and at police stations.” large-scale randomised controlled trial families.” (Young person) provided more than 1,000 counselling CEO and founder A primary assumption of the MST theory following 682 families co-ordinated by hours to vulnerable young people, BeatBullying and MindFull Rachel Hodkin of change is that adolescent antisocial University College London, the outcomes Jennifer McAuslane significantly increasing the capacity of Policy Officer behaviour is driven by the interplay of risk of which will be published in May 2014. Multisystemic Therapy Supervisor mental health care in the UK. Using the www.mindfull.org/get-mindfull/ Children are Unbeatable Alliance factors associated with multiple systems in The financial savings that can be made Sheffield City Council

10 PUBLIC HEALTH TODAY MARCH 2014 11 SPECIAL FEATURE: CHILD HEALTH SPECIAL FEATURE: CHILD HEALTH Going for gold with Putting the D back into child sport safeguarding development

WITH the 2014 Commonwealth Games in the community. around the corner, it’s hoped that a new Sport has physical benefits for children generation will be inspired to get involved and also provides opportunities for them to in sport. Scottish children’s charity develop self-esteem, confidence, leadership CHILDREN 1ST runs more than 50 services and teamwork skills. It can have a very aimed at giving children a safe, secure and powerful and positive influence if activities happy childhood. are led by adults who put the wellbeing of Twelve years ago there was no national children first and adopt practices that body in Scotland for ensuring children’s support, protect and empower them. wellbeing in sport. Although good work One of the service’s biggest was being carried out within individual achievements over the years has been in sports governing bodies (SGBs) and local prompting all SGBs to adopt minimum clubs, child protection lacked a consistent standards in child protection. Scotland’s and coordinated approach. National Guidance for Child Protection CHILDREN 1ST and Scotland’s national mentions Safeguarding in Sport as a ‘go agency for sport, sportscotland, joined to’ for help and advice. The team regularly TO TARGET inequalities and improve health forces in 2002 to create the Safeguarding contributes to the Scottish Government’s and wellbeing of children and families, we in Sport service. It provides case-specific Cross-Party Group on Sport. focus on reducing vitamin D deficiency in They matter to us all advice, training and resources to sports Most SGBs in Scotland have used the pregnant women and young children. We groups. It is an expert child protection service’sChildren resource in Sport 10 Steps to Safeguard have a significant number of children and Five months on from the England CMO’s report on child health, Leonora Weil, resource and produces guidance via as a basis for their own adults with vitamin D deficiency, the newsletters, meetings and a website. policies and procedures. But the biggest majority of whom are South Asian. From Jason Strelitz and Claire Lemer examine some responses and outcomes Safeguarding in Sport trains more than demand on the service is in relation to 2007 to 2010, 17 cases a year of rickets 400 Club Child Protection Officers every training and children’s welfare within sport. were diagnosed in Bradford children. Nearly year and takes around 150 calls a day on Often children will choose to tell a 2,000 women of childbearing age were subjects as diverse as training, poor trusted adult, such as their sports coach, diagnosed with severe vitamin D deficiency CHIEF Medical Officer (CMO) for England several areas. These include the need: “Perhaps more than the effect of any one practice and child abuse. Hundreds of about problems in their life. It is important, in Bradford between 2008 and 2010. Dame Sally Davies published her second n To assess the progress on early single recommendation, I believe that the coaches and people working with children therefore, that adults know how to We promote the effective treatment of

Annual Report (Advocacy Volume) on 24 intervention and prevention and to benefit of this report will be to remind us and young people in sport participate in respond appropriately and how to share people diagnosed with a vitamin D OctoberBetter: Prevention 2013. Our PaysChildren Deserve disseminate the evidence for why this all of how much the health and wellbeing basic child protection awareness courses. information with those who can help the deficiency and the use of supplements in outlines 24 matters (recommendation 2) of children matters to us all.” It is still too The aim is to ensure that children and child. It is equally essential that sports those at risk. We have developed a vitamin

recommendations to improve the health n To undertake a Healthy Child early to assess the full impact of this year’s young people can participate fully in organisations ensure that children are D pathway in partnership with GPs, and wellbeing of children and young Programme evidence-refresh annual report. However, the reaction to it sport, free from the risk of harm. More protected from abuse or poor practice paediatricians, early years staff, dietitians, people, including the initiation of an annual (recommendation 4); working with local and other recent publications on child recently the service has begun to embed within sport. Our training for coaches midwives and the voluntary sector. National Children’s Week and an emphasis authorities, schools and other relevant health has set a backdrop against which the ‘Getting It Right For Every Child’ includes information on recognising child We also promote vitamin and sunshine on the importance of school nurses. The agencies to increase participation in ‘ the medical community are now ready to principles in its materials using the abuse, responding to concerns and passing messages via leaflets and DVDs and have message underlying the whole report is that physical activity (recommendation 5) change the health and wellbeing of young SHANARRI assessment, so a child is safe, on this information to the appropriate developed early years settings training to “improving health and wellbeing in early life people. The way to achieve this is through healthy, achieving, nurtured, active, statutory service. promote safe and consistent sunshine benefits us all – not just through improved a coordinated response by key players. respected, responsible and included. This messages. We have trained more than 40 health gains but also economically”. There has already Local authorities have new responsibilities keeps the world of sport in line with our Campbell Bell local ‘vitamin D champions’ to target hard- The media focussed on recommendation been progress in that provide great potential to embed the partners in health and local authorities in Service Manager to-reach communities. Our clinical six, that the National Institute for Health several areas report’s core messages, such as early dealing with children and young people CHILDREN 1ST commissioning groups support increasing and Care Excellence (NICE) “examines the intervention.children, local The approaches recent Local Government Healthy Start vitamin uptake. All pregnant cost-effectiveness of moving the Healthy Association publication Bright futures: local women, babies aged up to six months and Start vitamin programme from a targeted n‘To identify how the health needs of shows what can at-risk children aged up to two years are to a universal offering”. The BBC, for families are met through the Troubled be achieved. Now is the time to remember offered free Healthy Start vitamins. example, framed an article around the Families Programme (recommendation 8) “how much the health and wellbeing of Evidence from August 2011 indicates headline “Call for free vitamins for n To aim to include paediatrics and child children matters to us all”. that 91% of the sample of pregnant children”. The headline in the Daily Mail health as part of the core component of women were taking a vitamin D was “Babies and young children should be GP training (recommendation 11) Leonora Weil supplement more than once a week and given free vitamins to ward off rickets as n For Public Health England to develop an Speciality Registrar in Public Health 81% daily. We aim to reduce vitamin D lack of time outdoors increases risk of adolescent health and wellbeing London Deanery deficiency rates significantly across our disease”. Medical organisations addressed framework (recommendation 16) Jason Strelitz population over the next few years. other recommendations. The British n For the National Institute for Health Acting Assistant Director of Public Health Medical Association centred on Research to work towards an evidence London boroughs of Camden and Shirley Brierley recommendation 10, that children with base to improve health outcomes for long- Islington Consultant in Public Health long-term health conditions should have a term conditions in childhood Claire Lemer Ruksana Sardar-Akram named GP to coordinate their care. (recommendation 22). Consultant in General Paediatrics Senior Public Health Manager There has already been progress in The CMO concludes her summary: Evelina London Children’s Hospital Bradford Metropolitan District Council

12 PUBLIC HEALTH TODAY MARCH 2014 13 SPECIAL FEATURE: CHILD HEALTH BOOKS & PUBLICATIONS

programme aims to offer the highly effective HIA. Each concludes with a set of learning How to make intra-nasal live vaccine to all children aged Learning from points for public health practitioners, 2-16 years. According to Dr Mary Ramsay, policymakers and researchers. Notable herd immunity Head of Immunisation at Public Health our friends in chapters include: Denmark and Slovakia, England: “Even with relatively modest Australia, New Zealand, Thailand, and herd mentality coverage, this programme has the potential HIA places Scotland. Every country has a different to interrupt transmission of influenza, thus story to tell, but there are striking providing protection to all of those at risk. READERS of Public Health Today will need similarities between them, such as the This will include those in communities who no convincing about the impact of public challenges of limited resources and are under-served by vaccination service and policy on the health of the population. capacity, the jostling for position among EVEN the Marmot review noted that those who cannot mount an adequate Health impact assessment (HIA) is a key the different impact assessments, and the childhood immunisations were among the response to the vaccination.” aspect of efforts to pursue healthy public difficulties encountered when it comes to most cost-effective public health Early indications show that this year policy, but how well is HIA actually implementing recommendations from HIAs. interventions. So why are there still alone, almost 40% of two and three year- integrated with the policy process, and In the final chapter, the editor concludes significant variations in uptake of vaccines olds – the first age group to be eligible for what lessons can be learned from with a recapitulation of the now familiar and vulnerability to disease, particularly in vaccination – have received the nasal spray. experiences around the world? In this themes, and a summary of the lessons enlightening to take a truly global view of areas of socio-economic deprivation? And Seven national early implementation sites Can of worms edited volume, Monica O’Mullane learned. This chapter feels somewhat a topic that is of great importance for what can we do about it? offered flu vaccines to primary-school-aged addresses these important questions. brief, given the magnitude of the territory global health. Vaccination demands absolute equality children. Two of the London early WELCOME to our live online advisory panel The first three chapters set the scene that has just been covered, and it would in access for it to be fully effective. implementation sites, Newham and where our three resident experts tackle your with a detailed exposition of the HIA have benefited from more detailed Ashley Sharp Without equity we cannot achieve the Havering, have achieved very different real-life public health problems. This week: literature. This section is very well commentary about the countries visited. holy grail of ‘herd immunity’ (if a referenced, so much so that the author’s The case studies are somewhat left to population has vaccination above a certain ‘My director of public health reeks of own voice gets a little lost at times, but it speak for themselves, and with only Integrating Health Impact threshold then non-vaccinated individuals alcohol. At yesterday’s Health and is nonetheless a concise and around ten pages each, there isn’t much Assessment with the Policy are also protected). This must be the focus Wellbeing Board he giggled, burped in the comprehensive account. room to do that, though the key messages Process: Lessons from around of all immunisation efforts. To do this, face of the Borough Commander and told The main body of the book comprises 14 do come through. the world we need to actively target ‘passive the Council Leader she was his best friend. country case studies, mainly dealing with Really, it is the breadth of countries Edited by Monica O’Mullane defaulters’, implement the National Can you suggest anything?’ national-level policy in developed countries, included that is this book’s most interesting Institute for Health and Care Excellence with a few glances at local policy, and the feature. Like a round-the-world tour, Published by Oxford University Press guidance fully and make sure that no-one Over to you panel: developing world. All chapters provide there perhaps isn’t time to get to know ISBN 9780199639960 falls through the net. Simply shrugging specific examples of HIA in use, and some any one country in depth, but we certainly RRP: £29.99 when 95% Cover of Vaccination Evaluated Councillor Roberts: What exactly is the present the results of local research into learn a lot from taking the trip. It is Rapidly (COVER) targets remain unmet is problem here? unacceptable – not just from a disease- Helene Healthwatch: He’s probably stressed. prevention perspective but also from a Roberts: Sounds like my sort of man safeguarding one. Healthwatch: Absolutely. Do you think he's Pro-vaccination campaigners ignored I thoroughly recommend this book to Immunisation is a key plank of the single? A tale of a big inconvenient truths such as the need for anyone interested in outbreak control and healthy child programme and every Dr Chadwick-Snow: Hello? Is this working? revaccination and side effects such as immunisation campaigns, as it has many healthcare professional who comes into Could I direct our conversation to the fact disease with a transmission of syphilis in arm-to-arm lessons for today’s practitioners. contact with children who consistently miss uptake. Havering, one of the least deprived that drinking at work must clearly be procedures. There is a detailed description immunisations should be asking why and boroughs in London achieved high uptake tackled as part of a wider strategic little name of the behaviour and motivation of the first Sally Millership whether it should give cause for concern. of 65-70%. Newham,one of the most approach to alcohol in the workplace? anti-vaccine campaigners. The strategies they

In England, commissioning responsibility deprived local authority areas in England, Roberts: Alcohol in the workplace? THIS fascinating book has something for used can be identified in the campaigns for immunisation services falls to NHS achieved close to 40%. Couldn’t agree more. Am in the Nag’s everyone. It is an enjoyable read with clear against MMR and other modern vaccines. Angel of Death: The Story of

England with expert advice from Public Nearly half of the parents in Newham Head right now, actually. explanations of the virology and The remaining sections of the book are Smallpox". Health England. But realistically these did not return consent forms, despite Healthwatch: immunology of the disease for the non- devoted to the response to outbreaks in the Gareth Williams agencies do not have the local levers to repeated chasing. Newham’s uptake was Roberts: Do all my work from here. There’s expert. There are detailed biographies of the last 100 years of smallpox, the political and affected by community concerns about the a 2 for 1 at lunchtime. Can’t afford not major players in variolation and vaccination. practical difficulties faced by those running Published by Palgrave Macmillan ‘ vaccine containing gelatin products of to!!!! There is a history of smallpox. I was surprised the final WHO eradication campaign and a ISBN 9780230302310 Newham’s uptake porcine origin. Although the gelatin used Chadwick-Snow: Ah, now I do hope you’re to learn that the severe disease described in rather dark chapter on the potential for re- RRP: £10.99 was affected by in vaccines had previously been declared drinking sensibly. textbooks only really became a problem over emergence as a biological weapon. Williams transformed (and therefore not prohibited) Roberts: Absolutely. And taking my most the world after AD1000, with curiously points out that we have repeatedly failed community concerns by many religious scholars, use of the new responsibility to be social very seriously. little mention in ancient texts before this to learn lessons on prompt identification, about the vaccine vaccine uncovered a wider diversity of Chadwick-Snow: Not more than 21 units a time. Gareth Williams describes the impact isolation and vaccination of contacts. week? of the disease on whole populations and Book brief ‘ containing gelatin opinion within the Muslim community. Over the next few years we will see the Roberts: A week! My a***! I drink that at its use as a biological weapon, particularly full roll-out of the children’s flu programme lunchtimes. Fancy a quick one Helene? during the conquest of the Americas. The STUDENTSDignity: Experience, and overseas potential visitors and are aspirations being Healthwatch: I’ll get my coat book will strike a chord with scientists in its offered a free copy of Disability With mobilise and reach communities, and need to all two to 16-year-olds. The programme of persons with disabilities in developing strong leadership support from local needs to be underpinned by a clear focus Chadwick-Snow: And that’s if you’re a description, not only of the trials and countries authorities and the community and on tackling health inequalities so that the man. Less for you Helene... And obviously tribulations of recognising a major discovery, voluntary sectors. benefits are experienced across all not more than 3 or 4 units in one sitting... but also the importance of publishing by Tom Fryers FFPH. It was Professor David Salisbury, who retired in communities. Hello?… Councillor?… Helene?… Anyone findings, gaining support from the rich and published two years ago by the charity December as Director of the Department of there? powerful and monitoring outcomes. Action for Disability in collaboration with a Health’s immunisation programme, devoted Thara Raj Chapters 11-13 include a thorough community-based rehabilitation programme his career to reducing inequalities in vaccine Public Health Specialist and Acting Got a problem? Tell [email protected].... examination of the mistakes made by all in Andhra Pradesh, India. The book contains uptake. He announced the introduction of Public Health Consultant … sides in the vaccination debate. 48 colour pictures. Qualified doctors pay £5 the largest childhood flu immunisation NHS England and Public Health Column written by Jenny Hacker, Governments made vaccination compulsory, and all receipts go to Action for Disability. programme that we have ever seen. The England Thara Raj and Dawn Reeves then realised the futility of this approach. Contact Dr Fryers at [email protected]

14 PUBLIC HEALTH TODAY MARCH 2014 15 ENDNOTES ENDNOTES

forthcoming book on global health in Asia. He had a particular interest in the effects In memoriam We will all miss him, but his spirit will of poor housing and rundown environments in my mind and helped distill some of membership – indeed, often as an remain with us and future generations. on health and was struck by the high levels the key issues we face as a body and as extension of it – there is broad Sian Griffiths of TB and emphysema being picked up by a community of interest. recognition of the value of a the mass X-ray unit in the poorest areas. Much of my time has been spent collaborative approach across the John Ashton writes: He was one of the first to introduce meeting agencies and individuals active wider public health community which I arrived in Hong Kong to join the launch smokeless zones following the 1956 Clean in the world of public health and could tap vital resources, capacity and of the World Health Organization (WHO) Air Act, and he spearheaded efforts to thinking about FPH’s position and role funding sources. Healthy Cities project a few days after the clear the dockside slums and re-house in this world – as well as getting to Ideas and plans are developing – both momentous decision had been taken to people in new estates on the city outskirts. understand the organisation itself: for this coming year and for future slaughter the city’s entire poultry flock to Andrew also championed public health membership, employees, finance, years. As I write, an outline strategy is contain the spread of SARS. SH was an approaches to inequalities in child and history, relationships and pressing issues under review by the FPH Board, and it is active advocate for this policy, believing adolescent health, introducing of the day. my intention to bring this draft to that the root cause of the 1997 epidemic immunisation for whooping cough and Although it’s early, it is already clear members and stakeholders for wide of H5N1 had been the wet markets for live polio and setting up one of the first health to me that some refreshment is required consultation in the coming months. fish and poultry. With H5N1 he had education units in the country. He was a in our thinking and approach to the Our 20 staff continue to impress me networked across government to make his shrewd political operator, as demonstrated From the CEO work of FPH. Clarifying the strategic with their commitment, expertise and views clear and to propose establishing by his ability to push through a free opportunities and developing ambitious enthusiasm - and are keen to work in more robust systems for environmental council-funded family-planning service Dear friends, but effective implementation – based new ways with our membership. Over- health control, just as he did years later at despite strong opposition at the time from on as consensual a strategy as we can riding all and any other insights I may Shui Hung ‘SH’ Lee FFPH the time of SARS when he joined the Liverpool’s sizeable Catholic minority. It has been a whirlwind first three muster – will take some time; but we have had in these early days is the 1933 – 2014 inquiry team into the epidemic. A skilled negotiator with a wicked sense months in post – perhaps cannot allow it to take too long. There realisation that FPH is nothing without In addition to being a consummate of humour, Andrew rounded off his career understandably given the steepness is too much to do, too many wrongs to active engagement from our members. PROFESSOR SH Lee was a giant of public political operator, SH was no less brilliant a as a board member of the Royal College of of my learning curve! I am grateful right, too many threats to the public’s I look forward to talking with you about health, not just in Hong Kong, but across teacher and mentor. It is testament to this Physicians’ Faculty of Public Health Medicine to all members, staff and colleagues health and wellbeing for complacency. how we best achieve our shared the global community. He travelled the that his protege, Margaret Chan, current (now the Faculty of Public Health) and from partner organisations for their The enthusiasm and capability of our ambitions for the future - for it is in our world in his tireless pursuit of promoting Director General of WHO, recently visited Chairman of the Royal Society of Health support, encouragement and community has become clear – as has hands. health, energising us with his boundless him in Hong Kong. The UK Faculty of (now the Royal Society for Public Health). willingness to share knowledge and the need to harness this to greatest enthusiasm for the idea that it was possible Public Health is proud that he was one of experience so freely. It has reinforced effect in an increasingly noisy David Allen to achieve Health for All – be it through its Fellows. I will miss him and so will the the breadth and scale of ‘public health’ environment. Outside our Chief Executive Officer Healthy Cities, better primary care, world of public health. community services or student ambassadors. Kulsum Winship FFPH As Director of Health for Hong Kong he 1930 – 2013 led initiatives to build up community health services across the colony. He would often BORN in Kenya, Dr Kulsum Winship was talk of the times when he visited fishing educated in Africa, Switzerland, India and communities in the New Territories, the UK. Joining the Department of Health, related organisations. Meaningful and sustainable solutions to the intractable reached only by boat, and of the where she was one of the first Asian Public Health engagement with those in diaspora who problems of capacity and capability within challenges of the influx of Vietnamese women appointed to a senior post, she are willing to contribute to the desired the African public health system. refugees which threatened to swamp the was part of a team that developed policies Africa outcomes has been almost non-existent. Hong Kong health services. for the management of disabled and The availability of these African diaspora PHA priority actions: SH always emphasised the importance of abused children and intensive care of groups, coupled with the UK government’s n Advocacy for health-focused public working with local communities and local newborns. She later moved into regulation current commitment to Africa, offers a policies across Africa and beyond government and was active in Healthy Cities of medicines and she reviewed the use of unique opportunity for an asset-based n Sharing and exchange programmes, eg. as well as in Healthy Schools. Hong Kong's drugs containing oestrogens, metals and THE public health challenges facing Africa approach that will complement and education and training success at reducing tobacco smoking rates herbal substances. are significantly greater than anywhere else strengthen the implementation of n Maximising the efficiency and to the lowest in the world is in no mean part As a council member of Breast Cancer in the world. With just over 10% of the sustaining solutions in the continent. effectiveness of existing resources by due to his efforts and unceasing support. He Care, Kulsum worked on improving world’s population, the continent carries a offering charitable consultancy services to held a deep conviction that better primary access, especially for women of ethnic quarter of the global burden of disease. Assets for a common and collective solution bilateral and multi-lateral public health care would improve the health of all Andrew Semple FFPH minority communities. She was also a Overpopulation and infrastructural and Public Health Africa (PHA) is a volunteer- programmes in Africa. populations, reflected in his call for a Primary 1912 – 2013 patron of Cherry Lodge Cancer Care in financial constraints contribute to the driven initiative by public health Care Authority in Hong Kong which he Barnet, Hertfordshire, and a published overall problem, as does limited capacity professionals. Its overall goal is to support PHA and partnerships championed for more than 20 years. DR ANDREW Semple was the Medical children’s author. and capability in the public health system the development of adequate capacity and The core assets of PHA lie in the dedication Not only was SH the founding President Officer of Health (MOH) for Liverpool City including the scarcity of an adequately capability of the African public health system and commitment of its volunteer members, of the Hong Kong College of Community Council for the two decades leading up to trained and skilled workforce. The latter is to bring about sustainable improvement in and its success depends largely on the Medicine but also the founder of the 1974 when ‘community physicians’ were exacerbated by a significant ‘brain-drain’ the health and wellbeing of Africans. strength of its partnerships. PHA strives to School of Public Health and Primary Care at transferred into the NHS. from the continent. PHA is a special interest group of the build and promote a culture of strong the Chinese University of Hong Kong where Andrew, a Scot, qualified in medicine at Deceased Britain has one of the largest Faculty of Public Health and specifically collaborations and coalitions for improving he remained active to the last. Students at Glasgow in 1934 and took up a series of concentrations of Africans from various aims to identify, mobilise and harness all the public’s health in Africa. Target partners all levels enjoyed his lectures, especially his assistant MOH posts in Paisley, Portsmouth members health professional backgrounds, including public health professionals with interest in include African governments, NGOs, donor stories of how Hong Kong had developed and Blackburn. During the war he joined The following members have public health. It also has an historically Africa (not restricted to Africans in government and its agencies, such as over the timespan of his long and illustrious the Royal Navy, achieving the rank of also passed away: strong commitment to the improvement of diaspora) to offer their skills and expertise. Public Health England and public health career. He was always there to provide surgeon-commander in the submarine the health status of Africa, largely through The pan-African and asset-based educational institutions. advice, give guidance and support and his service. Returning to public health he was Samuel Noel Donaldson its aid and development programmes. intentions of PHA represent the desire of smiling presence lit up many ceremonial appointed MOH for Liverpool in 1953 and, George Fyfe These are, however, carried out mainly the African public health volunteers to For more details, contact Aliko Ahmed at occasions. At a personal level he was a enjoying newfound power and influence, Christina Moody through bilateral and multi-lateral contribute to and complement initiatives [email protected] or Victor good friend. One of his last activities was immediately set about tackling some of the arrangements with governments and for providing comprehensive, large-scale Joseph at [email protected] to sign off the proofs for his chapter in the huge health inequalities across the city.

16 PUBLIC HEALTH TODAY MARCH 2014 17 ENDNOTES NOTICEBOARDNOTICEBOARD

Toxic second-hand smoke is especially FPH congratulates parliament for Policy update: dangerous to children’s health due to supporting the inclusion of enabling Welcome to new FPH members FPH in brief their smaller lungs and faster breathing. legislation in the Children and Families Bill. smoking The risks are increased in the small In the Lords, this happened without a vote; We would like to congratulate and welcome the following new members who were confines of the car. Every year, second- the vote in the Commons was admitted to FPH between December 2013 and February 2014 hand smoke in children results in around overwhelmingly in support of standardised 300,000 GP visits and nearly 10,000 packaging as well as proxy purchasing and FPH Annual General Meeting The 42nd Annual General Meeting of the hospital admissions. an age of sale for e-cigarettes of 18, with Fellows Claire King Faculty of Public Health will be held on MPs AND health campaigners celebrated a With more than 430,000 children being 453 in favour and only 24 against. Craig Blundred Heather Lewis 3 July 2014 at 12.40pm at Manchester major parliamentary victory in February, exposed on a weekly basis to second-hand A systematic review of peer reviewed Sophie Coronini-Cronberg Catherine Lowndes University. The agenda papers will be after the House of Commons backed new smoke in their family car, this vote is a studies carried out for the Department of Wendy Hatrick Kelly Mackenzie available in the FPH online members’ legislation to help prevent children from defining moment in the protection of Health found that plain standardised Sally Hogg William Maimaris area from 6 June 2014. Hard copies will starting to smoke. children’s health. There has been incredible packaging was less attractive, especially to Robert Howard David McConalogue be available on request from Caroline The House of Commons agreed a raft of support throughout from the public, young people, improves the effectiveness Sheena Ramsay Mark McGivern Wren at [email protected], Lords amendments to the Children and medical professions and politicians from of health warnings, reduces mistaken Jonathan Roberts Giles Ratcliffe tel. 020 3696 1464. Families Bill, to give the Health Secretary across parties. beliefs that some brands are ‘safer’ than Ian Scale Donald Read the power to bring in regulations: Parliament has spoken in favour of a ban others and is therefore likely to reduce Martin Smith Caroline Tomes n FPH elections Requiring cigarettes and other tobacco by giving the Government the ability to smoking uptake among children and Alexandra Stirling Emily van de Venter We are very pleased to advise the results of products to be sold in standardised outlaw smoking in cars carrying children. young people. Philip Veal the following elections: packaging We now look to the Government to Among existing adult smokers, two Michael Wade Specialty Registrars n n Vice President for Standards – Meradin Making it an offence to smoke in cars introduce this ban at the earliest thirds report that they began to smoke Timothy Crocker-Buque Peachey where children under 18 are present opportunity and build on the other before the age of 18, and almost two fifths Members Judith Eling n n Academic Registrar – Premila Webster Age of sale of 18 for e-cigarettes welcome tobacco control measures it has before the age of 16. The younger the age Kathryn Blackburn Charlotte Flynn n (re-elected unopposed) The bill also includes an amendment backed. at which smokers start, the greater the Carol Chatt Holly Jenkins n Treasurer – David Williams (re-elected prohibiting proxy purchasing of tobacco. You can find out more at: harm is likely to be, because early uptake is Helen Cruickshank Orsolina Martino unopposed) http://bit.ly/1gkgxrl associated with subsequent heavier Claire Currie Elizabeth Parry n Local Board Member, North East – Toks Smoking in cars smoking, higher dependency levels, lower Timothy Elwell-Sutton Darryl Quantz Sangowawa (elected unopposed) The amendment was passed by 376 Standardised packaging chances of quitting and higher death rates. Amanda Fletcher Susan Roberts n Local Board Member, South West – Sally votes to 107 in the House of Commons Standardised packaging of cigarettes and You can find out more at Lynn Gibbons Martin Ruramayi Rukuni with cross-party support, after the House other tobacco products is intended to http://bit.ly/1fTpObi Pearson (elected unopposed) Catherine Johnson Anna Schwappach n of Lords had voted in favour at the end make starting to smoke less attractive to Local Board Member, East of England – of January. children and young people. Mark Weiss Alistair Lipp (re-elected unopposed) n Local Board Member, Wales – Hugo van Woerden (elected unopposed). All those elected will take up office Health Today the following names immediately after the close of the AGM New public were placed in the wrong UKPHR route on 3 July 2014. Full details can be found category. We apologise for any in the FPH online members’ area or are The bridge between public health health inconvenience. Here are the correct available on request from Caroline Wren categories: at [email protected], and education specialists tel. 020 3696 1464 Training and examination route Rachel Cloke Appointment of new JPH editors In her most recent annual report, the Chief Medical Officer for England referred to PSHE education as the Lucy Denvir We are delighted to announce the “bridge between education and public health”. As the national association for PSHE education, we can Christopher Littlejohn appointmentPublic Health of Ted Schrecker and Eugene work with local authorities to help make this aspiration a reality in schools across the country. Congratulations to the following on Rebecca Reynolds Milne as the new editors of the Journal of achieving public health specialty . Ted is Professor of Global registration: Generalist portfolio route Health Policy at the School of Medicine, High-quality Personal, Social, Health and Economic (PSHE) education and health. Colin Thompson Pharmacy and Health at Durham education delivered in schools can make a significant Yet despite the importance of this agenda, Ofsted recently UK PUBLIC HEALTH REGISTER Michael Wade University. He moved to the UK from contribution to meeting a range of key Public Health Outcome concluded that PSHE education provision nationally is ‘Not Yet Canada in 2013 and has extensive editorial Framework indicators. These include: Good Enough’ (Ofsted PSHE education report, 2013), while Training and examination route Defined specialist portfolio route and manuscript-review experience. Eugene • Under 18 conceptions recent surveys suggest that it is being squeezed off the Craig Blundred Morag Armer was formerly Deputy Regional Director of • Excess weight in 4-5 and 10-11 year olds timetable in many schools. While many examples of good Sophie Coronini-Cronberg Terry Blair-Stevens Public Health for the North East Strategic • Smoking prevalence amongst 15 year olds practice remain, this trend is symptomatic of the challenges Anjan Ghosh Sharon Stoltz Health Authority and is now Director of • Hospital admissions as a result of self-harm posed to the health agenda in schools, putting this preventative Robert Howard Public Health in Newcastle. He is also an • Alcohol-related admissions to hospital plank of local authority public health strategies at risk. Sheena Ramsay GENERAL MEDICAL COUNCIL REGISTER honorary professor at Durham University. • Chlamydia diagnoses (15-24 year olds) The PSHE Association is keen to address this decline through Martin Smith Ted and Eugene will be working Schools are in a unique position to offer an almost universal staff professional development: perhaps the biggest challenge Rachel Beanland alongside Gabriel Leung until June, when public health intervention for children and young people; they for schools in delivering public health outcomes is staff training Generalist portfolio route Marie Casey Gabriel will formally step down as editor. also have excellent links to families and communities. Working – or lack of it. There is very little initial teacher training in public Kate Lees Kakoli Choudhury We would like to record our sincere thanks with schools is an ideal way to achieve public health objectives health, and none for PSHE education specifically. As the lead Anthony McGinty Ishani Kar-Purkayastha to both Gabriel and Selena Gray, who and to demonstrate partnership working between children’s national support body for PSHE education, we are well placed Jonathan Roberts Samia Latif stood down as editor in 2013, for all the services and public health teams. In her 2013 annual report, the to provide support. Please get in touch if we can help in any Annette Luker time, energy and commitment they gave to Chief Medical Officer referred to PSHE as a “bridge” between way in your area. Defined specialist portfolio route Susanna Roughton this role. The journal enjoyed considerable Mike Roberts Mohit Sharma success under the leadership and we very For further information visit www.pshe-association.org.uk/publichealth; [email protected]; 020 7922 7950 David Taylor-Robinson much look forward to working with Ted Correction: In the last edition of Public Sucharita Yarlagadda and Eugene on its future development.

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