PUBLIC HEALTH

PUBLIC HEALTH

'SHORT & SWEET' CRUK
1. WHY THE GOVERNMENT SHOULD INTRODUCE A SUGAR TAX
  1. OBESITY = BIGGEST PREVENTABLE CAUSE OF CANCER AFTER SMOKING
    1. CAN CAUSE 10 TYPES OF CANCER
      1. 2 OF THE MOST COMMON: BREAST & BOWEL
      2. 2 OF THE MOST DIFFICULT TO TREAT: OESOPHAGEAL & PANCREATIC
      3. NEW CASES OF CANCER: 670,000 OVER THE NEXT 20 YEARS
  2. KEY FINDINGS
    1. INTRODUCTION OF 20% SUGARY-DRINK TAX COULD AVOID 3.7 MILLION PEOPLE BEING OBESE BY 2025
      1. 5% SHIFT IN OBESITY PREVALENCE
      2. CURRENT TRENDS CONTINUE, THERE WILL BE A 5% INCREASE IN PREVALENCE: FROM 29% TO 34% BY 2025
    2. INTRODUCTION OF TAX COULD SAVE £10M OF DIRECT NHS HEALTH AND SOCIAL CARE COSTS IN 2025 ALONE
ALCOHOL AWARENESS CAMPAIGN
1. THE SUBSTANCE
  1. PLAYS SIGNIFICANT ROLE ECONOMICALLY & SOCIALLY
  2. EXTENSIVE MORBIDITY BURDEN ASSOCIATED WITH ALCOHOL USE
  3. PROBLEM DRINKING OFTEN ASSOCIATED WIT ALCOHOLISM
    1. DOMESTIC & PUBLIC VIOLENCE
    2. ACCIDENTS
    3. LOSS OF EMPLOYMENT
    4. HOWEVER, LARGE NO. OF PEOPLE WHO CONSUME HAZARDOUS AMOUNTS OF ALCOHOL WITHOUT CAUSING SUCH 'HAVOK'
      1. CHRONIC LIVER DISEASE + CIRRHOSIS HAVE BEEN ON THE RISE FOR THE LAST 50 YEARS
2. NHS LONDON SPENDS OVER £250 M A YEAR ON ALCOHOL ATTRIBUTED ADMISSIONS
  1. EQUIVALENT TO £34 FOR EVERY RESIDENT IN THE CAPITAL!
3. HIGHEST RATE OF ALCOHOL FOUND IN RESPONDENTS = MANAGERIAL / PROFESSIONAL (42.4%)
4. OPPORTUNITY FOR COMMUNITY PHARMACY TO DELIVER COMMUNITY-BASED SERVICES TRADITIONALLY PROVIDED BY GPs/HOSPITAL OUTPATIENT CLINICS TO THOSE WISHING TO STOP/REDUCE DRINKING
  1. MAY IN FUTURE REDUCE HOSPITAL ADMISSION RATES
5. SHOWING PROMISE IN PHARMACY SERVICES
  2. LONDON-WIDE COMMUNITY PH CAMPAIGN: DELIVERY OF AUDIT-C ALCOHOL USE ASSESSMENT TOOL: ACCEPTABLE TO MEN & WOMEN OF ALL AGES & ETHNICITIES IN LONDON
  3. IN 3 MONTHS, OVER 240,000 SCRATCH CARDS GIVEN OUT & OVER 23,800 RETURNED AND RECORDED IN ONLINE SYSTEM
    1. 43.5% RECORDED SCORE OF =>5, INDICATING HIGHER RISK OF DRINKING
  4. FINDING SUPPORT ARGUMENTS IN FAVOUR OF ENABLING COMMUNITY PHARMACIES TO DEVELOP FURTHER AS 'PUBLIC HEALTH' OR 'HEALTHY LIVING' CARE AND SUPPORT CENTRES
  5. FURTHER WORK NEEDED TO ESTABLISH MOST COST EFFECTIVE INTERVENTIONS & REFERRAL PRACTICES FOR PHARMACISTS SEEKING TO HELP THOSE WISHING TO REDUCE ALCOHOL RELATED AND ALLIED RISK LEVELS
  6. BEYOND THIS, PHARMACISTS CAN CONTRIBUTE TO PUBLIC AND PERSONAL HEALTH IMPROVEMENTS IN:...
    1. SEXUAL HEALTH
    2. SMOKING CESSATION
    3. WEIGHT MANAGEMENT
    4. PREVENTION OF HIGHLY PREVALENT CONDITIONS SUCH AS OESOPHAGEAL CANCER
6. HEALTH RISKS (ALCOHOL CONSUMPTION)
  1. BMA REPORTED THAT ALCOHOL CONTRIBUTES TO OVER 60 CONDITIONS (WHOLLY ALCOHOL RELATED VS. CHRONIC
  2. IN 2011, 8,748 ALCOHOL RELATED DEATHS IN THE UK
  3. CHRONIC HARM: LONGER PERIOD OF TIME WITH REGULAR DRINKING AT OR ABOVE RECOMMENDED 'SAFE' LIMITS
  4. LIVER DISEASE SEEN AS BAROMETER OF ALCOHOL RELATED ILL HEALTH ACCOUNTS; 4 / 5 DEATHS DUE TO LIVER CIRRHOSIS
7. IDENTIFYING HARMFUL & HAZARDOUS DRINKING
  1. PREVIOUS FOCUS ON PREVENTING UNDER-AGE DRINKING & PROVIDING HELP / TREATMENT FOR HEAVY DRINKERS
    1. HOWEVER! THIS COULD GLAMOURISE DRINKING, AND MAKE ALCOHOL CONSUMPTION AN EMBLEM OF ADULT STATUS
  2. PRESENT POLICY DOCUMENTS...
    1. A PROACTIVE ANTICIPATORY MULTIDISCIPLINARY HARM REDUCTION APPROACH
      1. HARM REDUCTION STRATEGIES
        EDUCATION & IDENTIFICATION OF 'AT-RISK' DRINKERS
        COMMUNICATION WITH CLIENTS ABOUT IMPACT & CONSEQUENCES OF ALCOHOL CONSUMPTION
    2. USING VARIETY OF PROFESSIONALS ACROSS HEALTH & SOCIAL CARE
    3. IN THIS MULTI-DISCIPLINARY/PROFESSIONAL CONTEXT, IT IS BECOMING INCREASINGLY RECOGNISED THAT PHARMACIES & PHARMACISTS ARE POTENTIAL ACTORS IN THE PH AGENDA
  3. IDENTIFICATION OF INDIVIDUALS THAT ARE DRINKING BEYOND LIMITS DEFINED AS 'SAFE''
  4. WHO DEVELOPED AUDIT QUESTIONNAIRE TO CONVERT APPROACH TO ALCOHOL MISUSE FROM REACTIVE TO PROACTICE
    1. TESTED AND VALIDATED IN 6 COUNTRIES, PROVED TO BE VALUABLE SCREENING TOOL IN BOTH PRIMARY & SECONDARY SETTINGS
      1. HOWEVER, AN AUDIT THAT TAKES A SHORT AMOUNT OF TIME (30S), SEEMED MORE VALUABLE & LIKELY TO BECOME A ROUTINE COMPONENT OF HEALTH & SOCIAL INTERVENTIONS 'AUDIT-C'
8. ROLE OF COMMUNITY PHARMACY IN ALCOHOL INTERVENTION
  1. 'CHOOSING HEALTH THROUGH PHARMACY': ALCOHOL PROBLEMS COULD BE ADDRESSED BY THE PHARMACIST
  2. THE WHITE PAPER: 'PHARMACY-BASED INTERACTIONS FOR PEOPLE WITH ALCOHOL PROBLEMS SHOULD BE FURTHER PILOTED & EVALUATED' (DoH)
  3. COMMUNITY PHARMACY COULD MAKE IMPORTANT CONTRIBUTIONS TO THE ALCOHOL PANDEMIC THROUGH DELIVERY OF OPPORTUNISTIC ADVICE, BRIEF INTERVENTIONS & OFFERING FLOOR SPACE TO OTHER HEALTH PROFESSIONALS
  4. ACCESSIBILITY & HIGH FOOTFALL OF COMMUNITY PHARMACY PROVIDES STAFF WITH OPPORTUNITY TO IDENTIFY PEOPLE WITH RISKY DRINKING BEHAVIOURS
  5. MUCH POTENTIAL FOR PHARMACISTS TO REGULARLY AND ROUTINELY ENQUIRE ABOUT ALCOHOL DRINKING BEHAVIOURS
  6. CONSUMERS WILL OFTEN PRESENT IN PHARMACY WITH SYMPTOMS ASSOCIATED WITH ALCOHOL MISUSE
    1. SLEEPING IRREGULARITIES, INDIGESTION AND GASTRIC PROBLEMS, REQUESTS FOR HANGOVER 'CURES' OR GENERALLY FEELING RUN DOWN
  7. PHARMACIST INTERVENTION
    1. SIGNPOSTING TO LOCAL CENTRE OFFERING PROFESSIONAL SUPPORT OR REFERRAL TO GP
    2. PROVISION OF LEAFLET DETAILING INFO AND ADVICE ON SAFER DRINKING
    3. BRIEF INTERVENTION & ADVICE HIGHLIGHTING PRACTICAL WAYS TO REDUCE ALCOHOL CONSUMPTION
WILL SMOKING MEET ITS MATCH?
1. PUBLIC HEALTH & SMOKING
  1. VITAL HEALTH PRIORITY - NATIONALLY & INTERNATIONALLY
  2. KILLED 100 M PEOPLE IN THE SECOND HALF OF THE 2OTH CENTURY & DISABLED MORE
    1. SMOKING RATES IN ADULTS HAVE FALLEN FROM 60% OF ADULTS AT THE START OF THE 1950s TO ~18% TODAY
  3. IN BRITAIN TODAY, IT IS THE MAJOR CAUSE OF CLASS-LINKED HEALTH INEQUALITIES
    1. STILL DECLINING, HOWEVER WHILE 600,000 PEOPLE STOP SMOKING EACH YEAR, ALMOST 300,000 START USING TOBACCO (TEENS/EARLY 20s)
  4. CIGARETTES KILL ~1/2 OF ALL LONG-TERM USERS & DISABLE MANY OF THEIR SURVIVING USERS
2. HEALTH RISKS
  1. NICOTINE CAUSES ADDICTION TO TOBACCO SMOKING
    1. HOWEVER, OTHER COMPONENTS OF TOBACCO SMOKE ARE THE KNOWN CAUSES OF DISEASE SUCH AS LUNG CANCER, COPD & ,HEART ATTACKS
    2. ALTHOUGH NICOTINE ADDICTION MAY EXACERBATE SOME FORMS OF MENTAL DISTRESS, IT IS NOT THE IMMEDIATE CAUSE OF OF SMOKING RELATED DEATH AND DISABILITY
      1. PEOPLE WHO REMAIN SMOKERS TODAY MAY BE MORE ADDICTED TO NICOTINE THAN THOSE WHO HAVE ALREADY QUIT
        THEREFORE, WILL FIND IT HARDER TO QUIT
  2. SMOKERS ARE TWICE AS LIKELY TO SUFFER FROM A MI THAN A NON SMOKER
3. STOP SMOKING
  1. 50% OF ALL QUIT ATTEMPTS ARE MADE WITHOUT THE USE OF MEDICINES AND OTHER AIDS (INCL. E-CIGARETTES)
  2. NICOTINE REPLACEMENT & OTHER STOP SMOKING MEDICINES WORK BY RELIEVING CRAVINGS & GIVING INDIVIDUALS TIME TO FREE THEMSELVES FROM BEHAVIOURAL ASPECTS OF SMOKING
  3. THERE IS EVIDENCE THAN COMBINATIONS OF PRESCRIBED MEDICINES AND PSYCHOLOGICAL SUPPORT SUPPLIED VIA THE NHS STOP SMOKING SERVICES OR SIMILAR PROFESSIONAL SOURCES: MORE LIKELY TO FACILITATE SUCCESSFUL QUIT ATTEMPTS THAN OTHER APPROACHES
    1. ALSO RECENT EVIDENCE THAT USING E-CIGARETTES IN SUPPORTED QUIT ATTEMPTS MAY PROVE SIMILARLY SUCCESSFUL
      1. HOWEVER ~90% OF E-CIGARETTE USERS AT ANY ONE TIME REPORT CONTINUING TOBACCO SMOKING ALONGSIDE 'VAPING' & MAJORITY OF THOSE WHO TRY IT, STOP AND RETURN BACK TO SMOKING
  4. IN SWEDEN, 'SNUS' DEMONSTRATES THE FACT THAT ALTERNATIVE 'NON-COMBUSTION' BASED APPROACHES TO NICOTINE DELIVERY CAN IMPROVE PUBLIC HEALTH
  5. RECENT DATA INDICATE THAT E-CIGARETTES AND OTHER UNLICENSED PRODUCTS PROMOTED AN ADDITIONAL 20,000 SUCCESSFUL ATTEMPTS TO STOP SMOKING 2013/2014
  6. THERE ARE UP TO 2 MILLION 'VAPERS' IN THE UK
    1. NUMBER OF CURRENT SMOKERS USING THEM IS FALLIN, BUT NUMBER OF EX-SMOKERS USING THEM IS RISING
  7. MANY SMOKERS DO NOT FIND CRAVING RELIEF WHEN 'VAPING', WHEN THIS EXTENDS THE PERIODS WHERE PTS COMBINE TOBACCO SMOKING WITH NICOTINE RELIEF, THIS WILL BE USELESS UNLESS IT RESULTS IN PERMANENT CESSATION
  8. E-CIGARETTES NOR STOP SMOKING MEDICINES CAN PROVIDE A MAGIC SOLUTION TO THE HARM SMOKING BRINGS TO INDICIDUALS, FAMILIES AND COMMUNITIES ALONE
  9. IF SMOKING IS BECOMING INCREASINGLY CONFINED TO SMALL SOCIALLY AND ECONOMICALLY DISADVANTAGED GROUPS & SELF-PURCHASED E-CIGARETTE USE IS BELIEVED TO BE SAFE AND AFFORDABLE, THERE WILL BE A DANGER THAT PUBLIC PROVISION OF OPTIMALLY EFFECTIVE STOP SMOKING SERVICES WILL CONTINUE TO DECLINE
    1. NO. OF PEOPLE USING NHS STOP SMOKING SERVICES AND SETTING QUIT DATES HAS DECLINED BY 25% BETWEEN 2011/2012 TO 2013/2014
      1. RECENT FIGURES SUGGEST THAT THIS FALL CONTINUES AND THE DECLINE BETWEEN 2011/2012 AND 2014/2015 COULD REACH 50%
        REASONS FOR FALL: INCREASED USE OF E-CIGARETTES & NHS REORGANISATION
        INSUFFICIENT INVESTMENT IN ADVERTISING TO STIMULATE THE USE OF PROFESSIONAL STOP SMOKING REPORT MAY HAVE CAUSED THIS
  10. STRONG PUBLIC INTEREST CASE FOR MAINTAINING OPTIMALLY EFFECTIVE STOP SMOKING SERVICES IN EVERY LOCALITY & IMPROVING THEIR APPEAL
    1. CHALLENGE TO ADDRESS: ''FAILED QUITTER' SYNDROME; COULD DISCOURAGE THE UPTAKE OF FORMAL CESSATION SERVICES AND STOP SMOKING MEDICINES
  11. STRONG PUBLIC INTEREST TO IMPROVE USE OF NRT & OTHER SMOKING CESSATION MEDICINES
    1. TREATMENTS ARE CURRENTLY UNDER-USED , THEREFORE DOSES FAIL TO PROVIDE CLINICAL BENEFIT
    2. SUGGESTED STEP: TO ENCOURAGE COMBINATION TREATMENTS & DEVELOPMENT OF MEDICINES DESIGNED TO SATISFY SMOKERS' CRAVINGS MORE FULLY THAN CURRENT FORMS
  12. DISAGREEMENTS ABOUT SMOKING CESSATION & HARM REDUCTION (WRT E-CIGARETTES/NRT) MAY DAMAGE COLLECTIVE ABILITY TO INFORM POLICY
    1. IMPORTANT TO SEEK TO OPTIMISE USE OF ALL METHODS AVAILABLE TO PURSUE GOAL OF SMOKING CESSATION & REDUCING PREMATURE DEATH & DISABILITY RATES
  13. IN EUROPE, IMPLEMENTATION OF 2014 REVISED TOBACCO PRODUCTS DIRECTIVE (TPD) WILL INTRODUCE CONTROLS ON VAPING FLUIDS & PRODUCTS AND FURTHER REGULATE PROMOTION
    1. HOWEVER, WITHOUT ADDITIONAL ACTIONS, THIS WILL NOT ASSURE MANUFACTURE QUALITY OR PROVIDE LEVEL OF SAFETY PROTECTION THE MEDICINES REGULATIONS OFFER
  14. 'SMOKER CENTRED' APPROACH COULD EFFECTIVELY END TOBACCO PANDEMIC IN ENGLAND DURING 2040s
    1. MOST PRESSING HEALTH POLICY OBJECTIVE TODAY: REDUCE INCIDENCE OF CONDITION SUCH AS CANCERS & COPD ASSOCIATED WITH CIGARETTE SMOKING BY ALL EFFECTIVE MEANS AVAILABLE
  15. IMPORTANT TO RESPECT INDIVIDUAL PREFERENCES WRT USING DRUGS SUCH AS NICOTINE FOR LEISURE
    1. HOWEVER, IF HEALTH = ACHIEVING A STATE OF OPTIMAL MENTAL, PHYSICAL & SOCIAL WELLBEING AS MUCH AS SIMPLY BEING FREE OF DIAGNOSED DISEASE...
      1. FACILITATING MASS NICOTINE ADDICTION THROUGHOUT THE 21ST CENTURY COULD PROVE A SUB-OPTIMAL SOCIETAL CHOICE
DEMENTIA DISEASE IMPACTS AND PREVENTION/TREATMENT

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	Created by Zinab Keshk about 8 years ago