Public health

Shared experiences

October 22, 2008 11:14 am

I had been meaning to mention Dipex for ages, but I was recently told that it had just changed its name to Healthtalkonline , which seems a good opportunity to write about it. It’s a compilation of interviews with people describing their experiences with illness. I think it’s a fabulous resource for patients, and for also friends and relatives. No matter how much one reads about the impact or difficulties of a condition, the view of someone who has also been there can be very helpful. I recommend it.

Posted in Public health | Permalink

Second Opinion: Rehabilitation through exercise

October 18, 2008 3:00 am

Chronic obstructive pulmonary disease is a blight on British health, estimated to cause 20 per cent of medical hospital admissions. Primarily caused by cigarette smoking, it is a condition that damages the airways and obstructs the flow of air from the lungs, leading to breathlessness, a chronic cough and wheezing. The symptoms are distressing and, as one might imagine, they have a significant effect on quality of life.

So what treatments for COPD can improve a patient’s wellbeing, mood and sense of control over the condition? The answer may be surprising, in part because we have become accustomed to hearing almost daily about “breakthroughs” in genetic decoding and state-of-the-art biotechnology. New drugs are permanently “on the horizon”.

The rest of this column can be read here. Please post comments below.

Posted in Public health, Testing treatments | Permalink

Walk while you work

October 13, 2008 9:42 am

There is pressure being placed on employers to make their workplaces “healthier”. NICE released documents on this earlier this year, and this week the Scottish Executive have published their take on matters.

What is the good employer to do? The recommendations focus on employers increasing the amount of exercise that employees take in the course of their work. Move the photocopier further away to make people walk more! Increase the distance between the water fountain and the desk! Put up signs beside the lifts to encourage people to take the stairs instead! Encourage short walks at break times! Move meetings further away!

NICE say these guidelines are evidence based, but there is nothing about how much time employees lose for the company while they are walking an extra mile or two a week. Or are people to work longer hours to get the same amount of work done? That doesn’t sound too “healthy” to me. Nor is there much in the way of long term evidence for these changes. There are many behavioural studies successfully examining how to encourage exercise that can demonstrate short term gain – but it is long term increases in movement which generate most health benefits.

I am dubious. My email correspondent in Virginia alerted me to this article in which he is
featured. It is a different and rather more vigorous idea: constant walking at the desk, via a treadmill underneath it.

Posted in Public health, Questions about healthcare | Permalink

Screening complications

October 7, 2008 12:06 pm

Regular readers will know that I have concerns about many tests used in the UK for screening. Screening tests are used when people are well, with no symptoms of disease. The aim of screening is to pick up a disease process at an early, pre-symptomatic stage such that an effective intervention can be used to prevent complications.

Real life is rarely that simple. A while ago I was asked (live on radio) for an example of a perfect screening test. Unfortunately, all I had to offer was a long silence as I tried (and failed) to think of one. Instead screening tests offer a balance of probabilities, and the risks and benefits of interventions which can then be offered are usually more complicated the more one examines them. (I’ve just finished reading Sir Muir Gray and Dr Angela Raffle’s excellent book Screening, Evidence and Practice. Raffle is a public health consultant, and Gray was the Programmes Director of the UK National Screening Programme from 96-07. The first line of the preface is ‘All screening programmes do harm’.)

Continue reading: “Screening complications”

Posted in Medical professionalism, Medical screening, Public health | Permalink

Is being vegetarian good for you?

September 20, 2008 3:00 am

Dr Rajendra Pachauri, who chairs the UN Intergovernmental Panel on Climate Change, wants us to eat less meat.

Pachauri is an economist (and a vegetarian) who believes that reducing meat consumption could also cut greenhouse gas emissions. The idea seems to make sense, since about one-fifth of global emissions are produced by the meat industry. I am already a semi-vegetarian: I avoid meat and only occasionally eat fish. This may be good for the environment, but is it any good for my health?

The question has always been hard to answer scientifically, for a number of reasons. Studies on the relationship between diet and health are often conducted retrospectively, which can cause problems. When, for example, a victim of a heart attack is asked about his or her dietary history, the response will be affected by “recall bias”. This means that present habits and events may influence perception of the past. In addition, it can be hard to ensure that individuals’ vegetarian diets are similar enough to act as a uniform comparison to carnivorous ones.

The remainder of this column can be read here. Please post comments below.

Posted in Public health | Permalink

The quiet claims of fruit and veg

September 2, 2008 9:45 am

There are yogurts with cholesterol-reducing properties and other dairy products which can supposedly produce “optimal” bowel health. Then there are baked beans with “added omega threes” and drinks that profess to reduce blood pressure. The European Food Safety Authority is now providing “opinions” on the science behind such claims. However a lot of the claims seem to rely on evidence about surrogate markers (eg a product may reduce cholesterol, however what we do not know if this method of reducing cholesterol will go on to have an effect on avoiding heart attacks or stroke.)

In the end, I suspect that there will not be many adverts rivalling the qualities of ordinary fruit and vegetables – generally for sale without much in the way of flashy health claims.

Posted in Effectiveness, Food, Public health | Permalink

Inequality kills

August 28, 2008 3:15 pm

The World Health Organisation are presenting their findings of a three year investigation into the ‘social determinants of health’ today. The report is available here. We are all used to hearing that the latest health news is ’shocking’ and ‘appalling’, but this report is a rare exception – it does actually deserve these descriptions. Life expectancy in one part of Glasgow is falling with a 28 year disparity in one part of the city compared to another. Maternal mortality in Indonesia is 3-4 times higher in the poor compared to the rich. They say “In the United States, 886 202 deaths would have been averted between 1991 and 2000 if mortality rates between white and African Americans were equalized”.

The report is rather brave. It talks about things like ‘social justice’ as a way to tackle health inequalities; for example, the importance of good urban developments, the need for fair and decent work, comprehensive social protection, the need for quality and equity in primary health care, and the problems with ‘practices that tolerate or actually promote unfair distribution of and access to power, wealth, and other necessary social resources’.

At the moment the best we seem to be doing to reduce health inequalities is to medicate more people with statins and antihypertensives. The ‘inverse care law’ as described by Julian Tudor Hart, suggests that the more people need medical care, the less they receive it, and I think this is true today. However I do not believe that real improvements in health can be tackled by addressing just access to healthcare. There is only so much that medication can do: low aspirations, unfulfilling employment, financial distress, a lack of control over one’s life, and little social cohesion have a huge influence on the quality of life and health. These need to be addressed holistically: ‘social justice’ is the right term for it.

Posted in Politics of healthcare, Public health, Questions about healthcare | Permalink

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