25 July 2006
To follow-up Mr Blair’s health speech this week, we held a webchat with Dr Fiona Adshead, the government’s Deputy Chief Medical Officer.
Read the transcript
Patricia Crew :
I am really tired of all the pronouncements made by you and rest of the government about the nation’s health. I don’t drink too much and I don’t smoke, I am overweight but I pay huge amounts of taxes and as such should be entitled to the best care (should it be necessary) that my contribution to the country’s funds entitles me to.
Dr Fiona replies: The NHS is absolutely about providing the best care but it is also about making people healthy. I am really pleased to hear you are healthy yourself but I am sure you can understand why some other people find it difficult to be healthy and need help and support.
minal patel: The proposed plan is huge, where will you start? I myself am a AHP and find it increasingly difficult to promote health issues to patients.
Dr Fiona replies: Healthy lifestyle is a really big challenge, you are right. I think for health professionals one of the things we would like to do is to give them a set of top tips for health so that you could have a chat with patients and start them off on good advice. I am sure that you know that one of the most powerful things you could do is constitently give patients advice about stopping smoking. Good luck with supporting patients health.
Mrs Lynn Watson: I haven’t seen any mention of exercise in all this? Sure, cut down on the fags and burgers, but what are you doing to encourage people to get off their backsides and burn some calories?! We need: more playing fields, less playstations
Dr Fiona replies: Last year was the first year that there were more playing fields so things are beginning to go in the right direction. You are absolutely right - exercise is key. Caroline Flint, the Public Health Minister, is leading on getting people active across government and as the PM said yesterday, the Olympics gives a fantastic opportunity to get Britain fitter for 2012.
Graham Lister: Obesity is also a parenting problem. Why not provide reports to parents together with action plans, guidance and support for those in greatest need?
Dr Fiona replies: Graham you are right. It is key that we provide key advice and support to parents. We recently published "Your Health, Your Weight" whch gives parents top tips on how to prevent their children from becoming overweight.
Trey Timms: Those public in4mation films in yr presentation offerd clear advice in a simple way. These days the advice is to complicated and confusing. Why not go back to simple films during big TV shows like Coronoation Street. Or Maybe some1 on Eastenders could lose weight or giv up smoking?
Dr Fiona replies: Role models in tv programmes really do help. In the past programmes like Eastenders have dealt with really important health issues such as cancer. What we know is that if people can see people struggling with health problems that we all might have, they actually find it easier to tackle the same problems themselves so you are on to a really good idea there. This is always more effective than telling people what to do like in the old information films.
Tony J: Why has obesity levels risen in recent yeras - shouldn’t we ban junk food to help us?
Dr Fiona replies: As the PM said we are taking childhood obesity really seriously and feel that we need to look closely at advertisign junk food to chldren. The government has already made a commitment to look in 2007 to see whether we have made sufficient progress and whether we need to follow up with legislation. So we do mean business.
Graham Lister: Yes this sort of general advice is good but perhaps it could be more specific to the child and family do we need to think about the role of the "school nurse" again?
Dr Fiona replies: I think school nurses are key. Part of our programme to tackle obesity will be to include them in a key role.
Richard Dinkeldein: Yesterday I was in a queue in a local foodstore. The hugely overweight woman ahead had selected the following purchases:
2 x Botles Full Strength Coca Cola
3 x Packets of potato crisps
3 x Large Mars bars
Why should I pay, through the NHS, for her almost inevitable treatment for diabetes, hip replacements, knee replacements, heart desease etc?
There must be a mechanism for charging people for the cost of treatment directly resulting from a life of willful self neglect. If people are careless for their own health then they should pay for that choice of life style through personal insurance premiums or payments to the NHS.
Dr Fiona replies: The National Health Service is there to provide everybody with care, irrespective of their need. If you have a skiing accident for example, the NHS will be there to help you. But we are saying that people need to have a shared responsibiltiy for their health and we do expect people with help, to do all they can to adopt a healthier lifestyle. One of the key issues is providing people with practical support where they live their everyday lives. Just giving people information isn’t enough.
Brian Whyte : The government have officially declared that ‘Smoking Kills’, yet there are no restrictions on parents smoking in the presence of their children, therefore I would be interested to know how the government intends to prevent parents from damaging their children’s health via passive smoking.
Dr Fiona replies: Our recent series of television ads focussed on just this issue. All our programmes including the forthcoming ban on smoking in public places, will help people to give up smoking, including parents. Particular support is provided for mums when they are pregnant, which is often a really good time for them to give up. Messages like "if you smoke, I smoke" are exactly the kind of thing we need to tell people so that they can understand that they can damage their childrens health.
rebecca jordan: There is a lot of emphasis on physical health and wellbeing - what can be done to raise public awareness about mental health issues, particularly in young people? This is a taboo subject but more and more young people are struggling with eating disorders, depression and stress-related mental illnesses. And behavioural problems cannot always be solved by giving children drugs.
Dr Fiona replies: Emotional wellbeing for young people is really important and it underpins most healthy choices. Programmes aimed at parents and young people, such as Sure Start and Healthy Schools, give people practical skills to improve their emotional wellbeing. But it is important to remember that some things, like exercise, that improve physical health, can also improve emotional wellbeing.
Joyce Monroe: I like the idea of people taking responsibility for their own health? What happened to the idea of people doing their own health check on line, to test their health and see what needs improvemenets? Thankyou Dr.
Dr Fiona replies: We are planning to launch an online health check life check as part of the service called "health direct". We are going to be testing out some of these ideas with people over the coming months.
Karen Bollan: Following up from Richard’s point and your response. Its more then shared responsibility. There must be underlying reasons why people make unhealthy choices. Its not as simple as will power, other wise no one would be overweight or smoke. Will there be more then advice, but counselling, therapy and opportunities to look at the ‘whole’ person not just the immediate problem they seem to have.
Dr Fiona replies: Karen, you are right. The whole point of social marketing, that we were talking about yesterday, is that it aims to understand why people carry out certain behaviours. If we don’t understand the why, we can’t really get to grips with how to help people. Often, for example, women quote smoking as a way of keeping off weight although in practice there is not much evidence to support this. If we don’t understand their concerns about weight gain, we are not going to be able to help them with giving up smoking. So I think you are right, we need to have a more sophisticated approach. Health trainers are there to help people as a whole person, not just looking at individual lifestyle issues, which is what we have tended to do in the past.
Sihem Bounoua: From my experience of buying healthy food with fresh fruit and vegetables, and cooking from scratch , there is no doubt that it costs more money than a meal of economy burgers, beans and chips. If I was living on benefits, and struggled to put food on the table for my children, I know what I would be buying in the supermarket. Why can’t the cost of fruit and vegetables be lowered to a price that the people that need it most can afford it?
To me, this seems like a vital step in making healthy eating accessible to those in society who suffer from ill health and reduced life expectancy because of their economic and social status. And there is no point giving school children healthy food at school if they are going to come home to burgers and chips, because that is what their family can afford.
Dr Fiona replies: In very deprived neighbourhoods, fruit and veg co-operatives have been a good way to get people cheap produce and its one of the reasons why we give children a free piece of school fruit. Next year as school childrens meals will include at least two pieces of fruit or veg, we should improve access for younger people. As you rightly suggest, food retailers also have a part to play in this and we need to think about people’s cooking skills. Again this helps achieve healthy eating. Some supermarkets claim that a healthy basket isn’t more expensive than an unhealthy basket but perhaps part of the trick is helping people to make affordable, healthy choices.
Nigel Simmond: I would like to ask the Doctor - how does the message to cut alcohol content marry up to the new 24-hour drinking laws?
Dr Fiona replies: Licensing laws give greater control to local authorities to control some of the adverse effects of the alcohol industry. So far, there hasn’t been any clear evidence of a harmful effect but we need to keep this under review. The messages for people around drinking are still very relevant because access to alcohol is equally common from supermarkets and other outlets and its not just about licensing hours. We are working with the alcohol industry to ensure they have high standards around corporate responsibility and that they play their role in pointing out the harm from alcohol. Again it is about getting the message right. Young people in particular worry about losing control and we are looking at these kinds of messages in our forthcoming campaign.
Karen Proctor: Why is the Government moving towards offering health care in shops like Boots? Are we saying the humble old GP can’t cope any more? Maybe we need more GPs, not cheap options on the High Street?
Dr Fiona replies: We are committed to making health advice accessible to everybody. Pharmacists have a key role in giving advice to people on stopping smoking and healthy eating. Boots, like other pharmacies, are committed to this. This week the announcements from Boots were around them providing office space for GPs, not saying that GPs don’t have a really important role to play in people’s health.
Tom Rayner: What will the on line health check, "Health Direct" be? Could it be used to build a national picture of the nation’s general health? Perhaps it could spot geographical trends?
Dr Fiona replies: Building a picture of the nation’s health is important. We have recently published some technical data around how we can describe health in local areas and in the autumn we are going to be thinking about how we can make this more widely available to the public. Life check at the moment is going to be about helping people build up a picture of their own health but perhaps over time, allowing for issues of confidentiality, we can think about how we can build a bigger picutre of health.
marie pye: Disabled people do not benefit from health initiatives to the same level as non disabled people. They are more likely to die of heart disease and cancer, more likely to smoke,. less likely to be reached by health promotion schemes. What can we do about this?
Dr Fiona replies: We really are advocating that health advice should be available for everybody but I do understand the difficult issue you raise. I would hope, as we develop health trainers, they would be able to provide advice for people with disability as well because clearly everybody should have the opportunity to be as healthy as they can be.
Mrs Gloria Campbell: Referring to the Prime Minister’s speech today on health issues - mentioned were smokers, drinkers and fat people. I did not hear the PM mention the drug problem which is also self-inflicted and costs the country a great deal of money. I have worked in the NHS at both hospital and Primary Care level and I still cannot see why the drug problem is dealt with as a health subject and not a social one. Nevertheless, it does cost the country a great deal of money with the amount of time given to drug users plus all the free prescriptions and incapacity benefit paid out to those who have never worked a day in their lives. Are we to look forward to an announcement about some real action to be taken to deal with this enormous problem?
Dr Fiona replies: The Government’s already got a very large, comprehensive programme on tackling drug problems. It does follow the lines you suggest of not only dealing with drugs as a medical problem but also thinking about the social consequences. A lot of work goes on in communities but also in prisons to deal with what is a very difficult and challenging problem in for individuals and communities.
Andy Jackson: Why did it take Jamie Oliver to speak up before you cleaned up school meals? Why don’t we just bring back the old-fashioned dinner ladies?
Dr Fiona replies: I think Jamie Oliver has done a fantastic job to demonstrate the practical issues that need to be addressed if we are to improve school meals. The "Choosing Health" white paper, published in 2004 highlighted issues around school meals and Jamie’s approach, working with government, schools, parents and children, is a good example of how we can really catch people’s imagination. You can read the white paper on our website www.dh.gov.uk.
Catherine Scott: What role do you think the voluntary and community sector could play in promoting healthy lifestyles? And how should the NHS support them?
Dr Fiona replies: Voluntary and community sector have a really key role to play. Ground work, a charity that improves urban environments, was part of the small change, big difference launch. They have done so much to change environments, provide play areas and get peole active through things like green gyms. It is exactly this kind of approach that will get England healthier.
Mr Robert Walker: I totally agree with you when you talk about individual responsibility for one’s health. However, I do feel that there is more that the government could do.
A government website with nurtitional information, a wide variety of healthy recipies (a nation’s cookbook?), and practical exercise suggestions (such as try to walk a mile a day) would be helpful. I am talking about practical, specific advice (as opposed to eat healthily and take 10,000 steps each day, which nobody can be bothered to count).
I realise that people need individual advice on exercise routines, but surely there must be a minimum level of exercise that all can take to increase their fitness?
Dr Fiona replies: Specific advice is absolutely key to this so that people know precisely what to do. Sport England’s everyday sport campaign gave people practical advice on how to get fitter, for example walking upstairs, getting off a stop earlier on the bus. These small changes can make a big difference to people’s health and as we take our work forward we will be looking to thinking about really practical messages so we can help people get more active. What we recommend is 5 times 30 minutes exercise a week, such as walking, but people making small changes for health but doing at least one of those and increasing each week could make a big difference
Gurjeet Bains: Asians have become integrated into British society but still face huge health problems as they have not been able to adjust their lifestyle to the British climate - 3 in 4 Asians suffer from diabetes. Yet the NHS does not spend enough money on educating Asians. Prevention is better then cure - why not for Asians
Dr Fiona replies: Prevention is for everybody. A lot of our approaches, like health trainers, and our basic health literacy approaches, aim to tailor solutions to different people but also to different communities. Communities sometimes come up with their own solutions. A really good example is some work in Warwickshire by Apnee Sahat who have produced cooking videos with and for the local asian community.
Diana Mason: I like what you have been saying, but perhaps there needs to be ‘joined-up thinking’ with all these different policies and initiatives? And it does seem that the govt never gives a policy long enough to work before it is replaced by a new one.
Dr Fiona replies: Joined up government is key which is why the PM has given Caroline Flint a role to link up all the approaches across government on physical activity. You’re right that things take time to work, for example we are just beginning to understand the benefits of approaches such as Sure Start and we do need to be persistent in our approaches. A good example of an approach we’ve stuck with, which is now proving to be really successful are stop smoking services where we are beginning to understand that investment, even in deprived communities, can really make a difference.
Sandra Cooper: I work for a Citizens Advice Bureau. Many of our clients have unhealthy lifestyles. How can we promote healthy lifestyles in a non-judgemental way? What support can we get in doing this?
Dr Fiona replies: Sandra, thank you. You have a really good opportunity to give people advice as you suggest. Perhaps we could use some of the top tips for health that we are going to be developing for the public a key source for you and your colleagues. Often the advice is really simple like trying to give up smoking but telling people that using nicotine repalacement therapy could make them more successful is often what people forget. Does that kind of approach sound helpful?
alan loughlin: if the PM is so concerned with public health why wait over a year for the smoking ban to come into force, the delay has cost many lives and much unnecessary cost to the healt service, the approach is hypocritical.
Dr Fiona replies: Key for us is getting the smoking ban right. It is important we take our time to consult with people, get the regulations right as we are trying to do at the moment and line up our approach for a big push to help people give up smoking. It is important to remember that we have brought the date forward from what was originally intended but the message remains for people not to wait for the ban, give up smoking now.
Diana Mason: Could say what you you will be doing to encourage doctors to see themselves as partners rather than leaders in healthcare, particularly GPs?
Do you agree that this is important element in providing services that emphasise health rather than illness and also to encourage people to take responsibility for their health and wellbeing?
Thank you
Dr Fiona replies: GPs have been at the forefront of medicine in trying to develop a different relationship with their patients. Seeing them as whole people, in their context of how they live their lives, programmes such as the Expert Patient, have further developed this approach and many GPs welcome this, seeing patients as leaders for their own health and illness. Most of health takes place outside the doctors surgergy where people live their lives, where they work, learn, play sports and relax. The key for us is to get the 50 million people in England motivated and engaged in improving their own health rather than just focusing on the role of NHS staff.
Dr Fiona says: Thanks to everybody for getting in touch. Sorry we haven’t been able to answer all your questions. Look forward to working with you to make those small changes we have been talking about a reality and hopefully a big difference for all of your health. Bye.
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