Archive for the ‘Public health’ Category

Peak health?

April 11, 2013

Something I’ve often wondered about before, and now a paper’s been published that touches on it (in terms of cardiovascular health, at least).

What happens next, in terms of life expectancy, in the developed world? First of all there was sanitation and better housing to reduce the disease burden from infectious diseases. And immunisation, of course. Then economic development and societal changes drive gains from the third stage of the demographic transition (ie better maternal and childhood nutrition reaps more healthy years of life decades later in the lifecourse). And we start to identify some of the big risk factors for disease, and belatedly, deal with them in a meaningful society-wide way (eg smoking bans).

Some of the benefit from these changes is yet to filter through to the life expectancy figures of course, but the era of big improvements is probably drawing to a close. Meanwhile, an overweight younger generation is coming through which is steadily accumulating a hefty burden of future cardiovascular risk.

So how are we going to sustain those improvements in life expectancy in the future?



Media Chaos and measles outbreaks

April 7, 2013

After the MMR scare comes the inevitable measles scare: there’s now a big outbreak in Swansea, Wales.

BBC report

What Wakefield et al sowed is now being reaped. No reports yet of deaths or serious disability, but unfortunately the odds of getting through the outbreak without them are poor.

Why Swansea? It has been suggested that an anti-MMR campaign spearheaded by the local rag in the 1990s may, in part, be responsible for lower MMR uptake in the region and loss of herd immunity.

Now, I heard/read about this somewhere in the media in the last couple of days, so it’s not as if there’s a big conspiracy to keep it quiet. But in other circumstances,  if the actions of a named individual, organisation (eg hospital), or even another professional group (eg doctors) could be deemed even part-responsible for an outbreak of potentially serious harm to a large group of people, I’d expect to hear a lot more about it in the news. But maybe the fact that the media aren’t saying much about their own failings shouldn’t be a big surprise.

Anyway, here’s a pretty good account of it on “the home of UK regional journalism and jobs”.


More linked reviews: Horizon ‘The Truth about Fat’ and ‘The Energy Glut’ by Ian Roberts

March 23, 2012

The Horizon programme, screened a couple of nights ago, promised to reveal the ‘surprising truth’ about what causes obesity, and ‘how to fight the fat epidemic’. Recently I read a book by  an epidemiology professor called Ian Roberts, “The Energy Glut”, which tackles similar questions, so I was interested to see whether the answers would match.

The short answer is: they don’t.


In Memoriam: Barbara Starfield

June 17, 2011

Some sad news that escaped my attention until today. Barbara Starfield died on 10th June.

While hardly a household name, she has been a vastly important figure in my professional life— well before I’d even heard of her. For over fifty years she conducted and collated research that largely established the effectiveness of primary care-oriented health systems over and above the effectiveness of specialty-based ones (France, with its secondary care-oriented system but good health outcomes, seems to be the main exception to the rule).

Here’s how:

1. Primary care increases access to health services for relatively deprived population groups.

2. The contribution of primary care to the quality of clinical care.

3. The impact of primary care on prevention.

4. The impact of primary care on the early management of health problems.

5. The accumulated contribution of primary care characteristics to more appropriate care.

6. The role of primary care in reducing unnecessary or inappropriate specialty care.

(Contribution of primary care to health systems and health, Starfield et al. Milbank Quarterly 2005.)

In other words, the World Health Organisation’s 1978 Alma Ata declaration was on the right track.

It’s an unsexy subject for non-public health research interested people, but it would be better for all if her work got wider recognition outside of the population health community. It’s a shame this recognition, when it comes, will have to be posthumous.

UK coalition health plans in a nutshell [with commentary]

December 1, 2010

Scrapping primary care trusts (PCTs) [neutral-to-good], replacing them with GP commissioning consortia to make local health services more responsive to local needs [sounds good but a minefield of conflicting interests for GPs; making services locally responsive does not make them regionally or nationally equitable].

Removing regulatory powers of NICE so that consortia make decisions to fund treatments on a local basis [=removal of main justification for NICE’s existence and return to postcode lotteries, so bad].

Moving public health function into local authorities [good in principle- if allows health considerations to more effectively influence housing, transport, and environment policy, but bad if leaves the public health profession distanced from NHS with limited influence over consortia].

Scrapping the Health Protection Agency (HPA) quango, and absorbing its functions into a new Public Health Service directly answerable to the Department of Health [pointless politics, bad if only because expensive and disruptive- does the Health Minister really want or need a role in containing pandemics?]

Cholera in Haiti

November 6, 2010

Haiti is having a bad year.

Nine months after the earthquake it has been estimated that 1 million people are still living in tents, and now there’s a cholera outbreak to deal with. These two facts are not unrelated— to quote the Pan American Health Organization:

Natural and man-made disasters which produce overcrowding, a scarcity of safe drinking water, improper elimination of human waste, and the contamination of food during or after its preparation are risk factors for the spread of the disease.

One question doing the rounds is where has the disease come from? Cholera has not been seen in Haiti since the 1960s. The presence of Nepalese soldiers in the United Nation’s mission to Haiti, and in the region of Haiti where the outbreak started, has been pointedly noted. Cholera is endemic in Nepal, with regular outbreaks occurring in rural regions during the wet season— and the strain in Haiti is indeed south Asian.

The Perfect Steak

September 7, 2010

A belated response to last month’s news.


The widest determinants of health

June 16, 2010

While the social and economic wider determinants of health are vitally important, we should remember the overall setting in which they apply.

Human health is dependent on an adequate food supply, clean air, and clean water. These represent the bottom line. The first two are required for cellular respiration— the basic reaction that converts chemical energy into walking, breathing, talking, and blogging— and the third is required as a reactant or solvent for almost all biochemical reactions in the human body.

US Healthcare Bill?

March 23, 2010

Seems like a good thing, as far as it goes— but I’ll readily admit to not understanding all the issues here. It’s a bit baffling from this side of the pond. The bill is basically about ensuring universal health insurance coverage, right? That sounds like a good idea, although it certainly won’t be enough (assuming that improving the overall health of the American population is your aim). I’ve seen stuff like this before, and the people over at Effect Measure seem to agree.

The cold curves of mortality

March 11, 2010

Though it’s still not exactly warm out there, in the UK we’ve at last come to the end of the coldest winter for 30-odd years. This was due to a more southerly-than-normal-for-the-time-of-year jet stream, as the somewhat controversial Paul Hudson explains here. He has an interesting if not entirely convincing (to this admitted non-meteorologist/climatologist) explanation which links the cold snap to the recent lack of sunspot activity. But that’s by-the-by.

The snow was photogenic and fun in the beginning, but persistent cold temperatures come with a price attached. This price is paid disproportionately within the population— and interestingly, disproportionately between populations, too.