The “miracle cure” – Exercise!

Guest Blog by Dr Iseult Roche

 Similar to the recommendations in Monday’s guest blog from the British Heart Foundation, the AcadeIseult Rochemy of the Medical Royal Colleges , has recently highlighted the importance of exercise and reinforced how important it is for Doctors to encourage this too.

The new report called Exercise:The miracle curehelps structure how doctors can issue exercise “prescriptions” and generally promote exercise among patients.

Although this may seem obvious and ‘common sense’ as most doctors already do this, in the day-to -day consultation, with an ever increasing number of life-style modifications and cessation advice that has to be given, exercise and its’s level of importance can be overlooked. 

GPs are in the best position to educate patients regarding exercise. Certainly the thought that exercise may have a beneficial impact on many long-term heath conditions including Dementia and Diabetes, highlights and focuses the level of importance that should be placed upon exercise promotion and accessibility .

However, this gimghumanfutureoes further than the GP practice –  it is a public health duty to encourage a variety of exercise options to people of all levels of ability and age, and perception must be changed too. A great deal has already been done to promote sport and physical activity across the UK, but emphasis must be placed on promoting this to all age groups, and enable suitable exercise accessibility for older people.

Prof John Wass, of the Royal College of Physicians, said: ” this report reinforce previous findings that regular physical activity of just 30 minutes, 5 times a week, can make a huge difference to a patient’s health.”

Chair of the Royal College of GPs, Dr Maureen Baker, is reported as saying “There is no doubt that exercise is beneficial for our patients’ physical and mental health – but the extent of the benefits, as outlined in this report, are astounding.

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Can just 10 minutes a day can benefit heart health?

Guest Blog by Dr Mike Knapton, Associate Medical Director at the British Heart Foundation.

KnaptonThis February the British Heart Foundation (BHF) is urging people to take just 10 minutes a day during Heart Month to help cut their risk of heart attack and stroke.

Worryingly, there are more than seven million people in the UK living with cardiovascular disease (CVD), and latest statistics show that lifestyle habits are getting worse.

Less than a third of adults in England are eating fives portions of fruit and vegetables a day1 and households are buying fewer vegetables per person1.

People aren’t doing enough regular exercise with nearly half of adults saying they never do any moderate physical activity2.

In a recent survey3, the public told us loud and clear that time, motivation and money are fundamental barriers to a healthy lifestyle.

And around 40 per cent people said they were worried about the effect that their current diet and exercise habits have on their health3.

But we know that even small, simple changes to everyday habits can make a big difference for heart health, and are achievable by everyone.

It is possible that people who try to drastically overhaul their lifestyle with New Year resolutions, may fail by February because they try to take too much on.

Nearly a fifth of people told us they often set themselves goals for improving their lifestyle, but usually fail3.

For people who struggle to fit any exercise into their busy regime, the thought of 150 minutes a week could put them off altogether.

We support the current guideline but believe that people can get there by starting off with small bouts of at least 10 minutes a day that would put them on a path to a healthier lifestyle.

Whether it’s getting off the bus two stops earlier, using the stairs rather than a lift or dancing for ten minutes to your favourite album, there are lots of ways to start introducing extra exercise into your daily routine.

If you’re looking to improve your diet, making small changes such as swapping a sugary fizzy drink for a glass of water, or swapping sweets for a piece of fruit, would be beneficial to heart health.

Rather than using salt, you could flavour your food with pepper, herbs, garlic, spices or lemon juice instead.

So our message is simple, anything is better than nothing, and taking small actions to improve your heart health will help decrease your risk of developing CVD.

ENDS

Heart Month

bhf-logoDuring Heart Month the BHF is offering an email support programme and advice to help people improve their diet, get more active or quit smoking. For more information about the Heart Month 10 minute challenge visit www.bhf.org.uk/heartmonth or join the conversation on social media using the hashtag, #10MinChallenge.

References:

1) Cardiovascular Disease Statistics 2014, British Heart Foundation Centre on Population Approaches for Non-Communicable Disease Prevention. Nuffield Department of Population Health, University of Oxford

2) Physical Activity Statistics 2015, British Heart Foundation Centre on Population Approaches for Non-Communicable Disease Prevention. Nuffield Department of Population Health, University of Oxford

3) All figures, unless otherwise stated, are from YouGov Plc.  Total sample size was 4,766 UK adults. Fieldwork was undertaken between 16th-20th January 2015.  The survey was carried out online. The figures have been weighted and are representative of all UK adults (aged 18+)

4) Effect of Intensity and Type of Physical Activity on Mortality: Results From the Whitehall II Cohort Study

The BHF Alliance
If your role plays a part in the prevention, survival or support of people with or at risk from CVD, you are eligible to join our free membership organisation, the BHF Alliance. The Alliance seeks to grow and nurture a supportive and inspirational network in which every member can maximise their potential to make a difference, and share experiences to assist the development of others. Our Alliance members are equipped with support, information and resources to help them impact positively on patient care, service improvement, prevention of disease and survival rates from sudden cardiovascular events. Visit https://www.bhf.org.uk/healthcare-professionals/bhf-alliance to join the Alliance.

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Have you made ‘Time to Talk’ today?

Guest Blog by Jon Paxman

Today is ‘Time to Talk Day’, where you are encouraged to have just one 5-minute conversation about mental health. The chances are, whoever you talk to (including teenagers), you will be able to discuss mental illness from personal experience or with intimate familiarity.  Among people under 65, nearly half of all ill health is mental illness – the most common conditions being depression and/or anxiety. During the course of a year, around one in four of us experience some kind of mental health problem.

Today’s campaign has been instigated by Time To Change, a partnership initiative between the charities MIND and Rethink Mental Illness which aims to end the stigma and discrimination faced by people with mental health problems. We think nothing of discussing our physical ailments, yet we’re so reluctant to broach mental health. The message from Time to Change is simple: ‘just talk about it’. You can begin with the opener: “Did you know it’s ‘Time to Talk Day’ today?” And you’re off.

Your conversation may turn light-hearted, but be prepared to talk about mental illness as you would about a serious physical illness. Many understand schizophrenia and bipolar disorder as ‘serious’, but so too are common mental illnesses. Eight years ago a study by the World Health Organisation of self-reported conditions concluded that major depression causes greater detriment to health than a single chronic condition of asthma, angina, diabetes or arthritis. The WHO considers depression to be the leading cause of disability in Europe.

It is also important to recognise the bilateral relationship of mind and body. This goes beyond headaches and backache from stress and anxiety: the BMA have recently cited evidence that common mental illness may be variously a cause and a consequence of serious physical illnesses, including cardiovascular disease, cancer, epilepsy, diabetes and stroke.

So in a sense, we are simply talking about ‘health’ – period. Recognition of this fact is an important step towards what policy makers and many in health care are calling ‘parity of esteem’. That is, valuing and recognising mental health as equally important to physical health. 

Our workplaces, schools and communities need to drive ‘parity of esteem’ culture change. Culture change will not come from the NHS. In a caring society there should be no barrier to asking someone how they are, and inviting a meaningful conversation. And if you’re an employer you have both humanitarian and business reasons to create open dialogue around mental health in the workplace. The Deputy Prime Minister’s office and Department of Health estimate that British businesses lose around £1,000 per employee every year to common mental illnesses – some £30bn in total.

The importance of today, therefore, is not to instigate one short discussion on mental health and leave it there for another 12 months. Rather, it is an opportunity to begin an open, non-judgmental dialogue that breaks the silence around mental illness.

For more information go to Time to Change .

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Anxiety, Dementia and evolving holistic care

Guest Blog by Dr Iseult Roche

Last year I wrote a blog, (dementia..what’s  in a name) considering the importance and implications of labeling someone with “Dementia”. I  know still from many anecdotal conversations, that some older people are very worried about attending their GP in case they should be met with a Cognitive based assessment, rather than their repeat prescription review.

Recent research has assessed the link between anxiety, Alzheimer’s and Dementia.  The Baycrest Health Sciences Rotman Research Institute  has  highlighted that people with mild cognitive impairment,  decline significantly faster towards dementia from Alzheimer’s disease, when they also suffer from anxiety. Researchers evaluated material from the Alzheimer’s Disease Neuroimaging Initiative, and evaluated  anxiety and depression, with cognitive function and the structural brain cortical changes – in nearly  400 adults between 55-91 years ( all had  amnestic MCI and were not depressed)  each person was monitored at 6 monthly intervals over a 36-months. 

The results identified that in  mild, moderate, or severe anxiety, the risk of progressing to dementia from Alzheimer’s was increased by 33%, 78%, and 135%.

Notably, patients  who reported anxiety symptoms had greater atrophy. It waold womans concluded that this suggests  anxiety is a predictive factor for converting to Alzheimer’s, however, Medscapes recent choice of title ” Anxiety: Speeding the decline to Dementia?” is poignant and does beg for consideration – which comes first?

This is yet another issue that patients with MCI may worry about and yet another ethical and real concern for physicians and their teams, when balancing the all important holistic long term care in such chronic conditions.

‘My Name is…’ – Why its not enough?

A Patients Personal Perspective:
In the weeks before Christmas I went for my flu and pneumonia jabs.  I had been phoned by the surgery to go and was seen by the doctor’s assistant.  The relevant jabs were given and then with no warning I was told I had to have a memory test.  No rationale was given; the assistant launched into her script and then the questioning began.  I answered as best I could reciting the months of the year backwards from December, counting back from twenty to one and being questioned on a name and various details given before the questions were asked.  I have no idea how I did.  No result was given to me.  No explanation was offered as to why I had been chosen to have the test. I presume this was due to the fact that I am in my late 60s.  I had certainly not asked for this test, nor had its implications been outlined to me.

Do I have a bad memory?  Well it is not perfect but I manage pretty well most of the time.  If I had gone to the doctor with a problem or a relative had taken me because I was worried about my memory then I would have been grateful for such a test.  Now I feel I am just part of a money raising exercise by my practice and worried about my score! On this day where terminally ill NHS Doctor Kate Granger’s campaign – to have staff all greet us with #HelloMyNameIs – has hit the national headlines, it seems that having some manners and giving people the dignity of respect is where the NHS needs to start.


References
Mah L, Binns MA, Steffens DC; Alzheimer’s Disease Neuroimaging Initiative. Anxiety symptoms in amnestic mild cognitive impairment are associated with medial temporal atrophy and predict conversion to Alzheimer disease. Am J Geriatr Psychiatry. 2014 Oct 29. http://www.medscape.com

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How can A&E units improve their performance?

The first point that I must make is that I do not wish to appear unappreciative or condescending. Hospital A&E work is amongst the most important that any person can undertake and many of us would find the strain unbearable. I have nothing but admiration for the doctors and nurses who work unsocial, long shifts, take life and death decisions and have to put up with stressed patients and carers as well as people who should not really be in A&E at all.

I have never worked in A&E or for the NHS and am not medically qualified. My interest derives from having been an investment analyst specialising in healthcare for thirty years and more latterly from my role as an elected Councillor. Opinions in this blog are entirely my own and are intended to stimulate constructive debate and study, not to offer final solutions. I certainly would not to be so arrogant as to think that I know better than medical professionals working at the coal face. Where I am wrong I hope readers will tell me by posting a comment on this blog or tweeting @barbararesearch .

International data on the performance of A&E is difficult to compare because the systems, categories and data collected vary considerably around the world. The UK does, however, rate relatively highly. All counties are experiencing financial pressure over healthcare spending. Life expectancy is rising more rapidly than the typical retirement age. As a result the proportion of elderly people in the population is rising, leading to healthcare costs growing in relation to the economy. Medical advances intensify the pressure since improved healthcare is usually more expensive than what went before and is also an important driving force behind increased longevity.

The financial pressures on A&E departments reflect partly the demographic trends behind healthcare, partly the need to fund medical advances along with R&D and partly the limited alternatives especially out of hours. Pressures on the NHS outside A&E are also a factor and largely result from the same underlying trends.

Improving the performance of A&E units is certainly a major challenge. The issues are complex. Many ideas about the deficiencies of A&E departments are either mistaken or overly simplistic. For example, conventional wisdom is that money would be saved if more people who attend A&E without urgent medical needs went to their GP instead. This belief is based on figures suggesting that an A&E assessment costs around £110, roughly three times higher than the GP equivalent. However, common sense suggests that this analysis is wrong. Why should it cost more for a junior hospital doctor to give an opinion in an A&E unit than for a more highly paid GP to do so instead? The likely explanation is that on average cases in A&E really are more complicated and more urgent, pushing up average costs. Patients who should not really have come to A&E ought not to need to see anyone more senior than a junior hospital doctor.

Another suggestion that does not fully fit the facts is that the main cause of pressure on A&E departments is growing difficulty in seeing a GP at short notice or out of hours. The time for which patients have to wait before an available appointment with a GP has recently been moving roughly in line with the normal seasonal pattern. A&E on the other hand has recently seen demand grow by much more than normal. In addition, the hourly pattern of A&E attendance over the course of a day has not changed significantly. A change in hourly attendances in A&E would be expected if the problem was caused mainly by a reduction in the out-of-hours services of GPs.

Yet another myth is that NHS 111, the official NHS medical telephone helpline, is increasing the workload on A&E departments. In fact, only around 8% of calls handled by NHS 111 result in advice to attend A&E. Moreover, 30% of callers say that they would have gone to A&E if NHS 111 had not existed. The truth is that NHS 111 helps to divert patients from A&E rather than adding to those attending.

What can be done to help A&E?

  1. Improve Management. Progress has been made over increased cooperation between hospital staff and teams. However, every A&E unit is different as illustrated by the fact that CQC criticisms of A&E vary considerably between hospitals. Meeting the main Government-imposed targets does not in itself mean that all is well. Every A&E unit would benefit from having one person in overall charge with wide ranging powers, just as a country usually has one prime minister (or equivalent) and a company normally has one chief executive. The person selected should have strong leadership qualities and knowledge of A&E. He or she may have other duties apart from managing A&E and might usually work normal office hours. The person chosen should simply be the best for the job and could be a doctor, professional manager or someone from another medical profession.
  2. Eliminate bottle-necks. In my experience the longest wait in A&E is usually before seeing a doctor but after a nurse has obtained brief details. One extra junior doctor on duty at all times would have a significant effect on the performances of some A&E departments. Whilst A&E units vary considerably, on average they see about 270 patients per day. The total running costs of all A&E departments in England add up to around £2.6 bn per annum, which corresponds to the attendance of 21.7 m patients at a total of 218 providers. The average number of doctors employed by an A&E department is around 25, of whom about 10 are on duty at any one time. The 25 doctors would typically include about 5 consultants, although sometimes there may be none present at night or weekends. At least one consultant is always on call.The extra cost of having one more junior doctor on duty at all times in an A&E department would on average add about 1% to the department’s total A&E costs. An extra consultant at all times would increase costs by about 3%. With good management and appropriate recruitment the way forward for A&E departments would look much less problematical. The key hurdle is that recruitment is easier said than done.
  3. Recruiting staff. Every A&E unit should carry out a detailed analysis of the movement of patients through the facility in order to determine the optimum staffing level for doctors of different levels of seniority and likewise for nurses. The analysis needs to take into account unexpected peaks in numbers of patients, the fact that patients do not arrive at regular intervals and the unexpected absence of staff (e.g. due to illness). The NHS could have a small central team available to help A&E units on request with their statistical analysis and to provide appropriate software. Any bottlenecks that do not relate to staff numbers should also be studied thoroughly. The biggest obstacle standing in the way of major improvements in A&E departments is not money but rather real difficulty in recruiting and retaining doctors. A&E has amongst the least attractive shift working arrangements, the highest workplace stress levels and the least opportunity for private practice. The NHS has tried various approaches aimed at attempting to overcome the A&E labour shortage. Steps have been taken to recruit foreign doctors. Many GPs in England have accepted positions in A&E units and this trend could be reinforced by allowing GPs to establish surgeries in hospitals close to A&E units and with shared facilities. The problems of some GPs in finding affordable accommodation for their practices could thereby be lessened. A new GP contract could allow the GP practices located in hospitals to take some of the load off A&E departments whilst allowing the GPs to continue their own unrelated practices. The difficulty in recruiting A&E doctors has resulted in total A&E expenditure on locum doctors reaching around £80m per annum in England. Locums cost much more than permanent staff. If the money spent on locums were used instead for permanent staff each A&E department could have both a permanent extra junior doctor and an extra consultant on duty at all times.The official Government target is for 95% of A&E attendees to be admitted to hospital, transferred or discharged within four hours of arrival. The worst A&E waiting times for England as a whole in recent years occurred in the week to 4th January 2015, when only 86.7% of attendees had a wait of less than four hours. This failure is not as bad as it might appear. In a typical A&E department seeing 270 patients per day the Government’s target would have been met even in this very bad week if just 22 more people had experienced a wait of under 4 hours. One extra junior doctor and one extra consultant on duty at all times would have been more than sufficient to enable the unit to achieve the Government target providing that the 22 patients did not arrive too closely together.
  1. Size of A&E Departments. There are many powerful arguments for having fewer, larger A&E units and only one against doing so. The case against having fewer units is that on average it will take longer to get to the nearest. However, the time taken to get to hospital is less critical than seems intuitively right. There can be no denying that for some patients every minute counts and delays will be fatal. However, for most critically ill patients quality of care affects the outcome more than speed. Most very urgent treatment can be given in ambulances (e.g. stopping severe haemorrhages, resuscitation). Journey time to hospital is only one factor in determining how quickly treatment can begin. Other factors may include, for example, diagnostic tests, x-rays, getting the opinion of a suitable consultant, getting an operating theatre ready, getting necessary drugs from the hospital pharmacy, securing a hospital bed in an appropriate ward and obtaining a medical history (especially if the patient is unconscious or delirious). Valuable time to offset longer ambulance journeys could be saved partly by educating the Public about when to call for an ambulance. Undesirable delays in summoning an ambulance and requesting one unnecessarily should ideally both be addressed. Ways can be explored to help speed the journeys of patients not arriving by ambulance. For example, special 15-minute parking bays for use by drivers offloading patients could be made available near to A&E units.

The advantages of large A&E facilities are:

  • More specialist teams will be possible within A&E or at the same hospital e.g. for strokes, heart attacks, trauma, asthma, diabetes.
  • Peaks and troughs in patient attendance and staff availability will be more predictable.
  • More flexibility will exist to direct medical attention where it is needed and to call on other hospital departments especially when understaffed.
  • A greater range of equipment may be available.A&E closures should be avoided unless it can be clearly demonstrated that the overall effect is to improve medical services and help patients.
  1. The Long-term future. The long-term pressures on A&E are inevitable, given the long-term demographic trends and medical advances. The problems are global. All we can do is to strive to become ever more efficient and to allocate adequate resources. Attracting more doctors and nurses into A&E without paying them more is not going to be easy but a review and consultation about improving working conditions could only help.
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Reflections on Andy Burnham’s speech

Before I give you the complete low down, there were some exceptional comments that came midway and at the end of Andy Burnham’s speech on Labour’s ten year plan for health and social care today. Midway through, he spoke about a ‘national entitlement’ to end the postcode lottery of care. If a service was available in one area, it would be available in every area. This is a significant promise which repudiates the current direction of travel: no more local decision making on what is provided, only on how. We called last year for a National Service Guarantee that would give that same certainty to everyone. The challenge is deciding what is left out.

The second comment of note was at the end and built on the one above: “The NHS can’t do everything”, he said, “we have to do more for ourselves, our families, our neighbours. Taking out of the NHS only what we need” and “reset our expectations”. “We need a national debate over which direction the NHS takes”. I do believe that this is a political first. For all else that was said, and what was omitted (IT infrastructure; the effect of rapidly growing digital health and diagnostic technologies; research, innovation & growth; personal healthcare records under our control, how to integrate a means tested service with a free-at-the-point-of-use service), this is the conversation we have been calling for. Anyone who looks at the predicted growth in funding that the NHS will need – driven by more people living longer with long-term conditions, a higher prevalence of complex needs, exponential growth in medical and digital technology capabilities & personalised genomic medicine – and takes the bigger economic picture into account (falling earner to over 70s ratio, balance of payments deficit etc), will know that the NHS cannot go on promising everything to everyone.

Andy Burnham is to be commended for being so frank. The sooner we can begin to review the growing demands against realistic budgets, the sooner the public will be able to partake in an informed discussion on what the NHS in the 21st century is for, how it can be fair, what we must do for ourselves, and what the choices are before us. The NHS is too precious for us not to be having these discussions.

The low down as I heard it….

Sir John Oldham kicked off Labour’s 10 year plan for health and social care this morning, but not before King’s Fund chief Chris Ham had said all (three?) political parties had been invited to set out their stalls – and implied only Labour had taken up the offer so far.

Joint commissioning is essential for integrated care Sir John said, and joint leadership development too. He asked (rhetorically) why there were no local authority representatives on the NHS England Board, and why there were umpteen different national clinical directors for different body parts…NCDs take note!

Fiona Philips introduced Andy Burnham who immediately quoted our by-line as his ambition: Making Health Personal, which was very kind of him, although he didn’t credit us. Andy talked about what he has learned, both from Sir John’s and other reports, but also while listening to the front-line over the past two years citing four themes:

  • Clarity – hence his emphasis on person centred care facilitated by one team
  • Stability – so he has set the path to integration as a ten year journey with no new structural reorganisation
  • Flexibility – he knows integration can’t be mandated from on high but relationships need to be built at the coal face
  • Consensus – getting the right values at the centre and a focus on whole person care is essential

He then went on to give more detail in five areas: Competition, National vs local health, Money, Organisations and Empowering professionals and people, although there were the recurrent themes throughout of integration, personalisation and bringing mental, social and physical care together.

On Competition, Andy said he would call time on the market experiment “market forces will break the NHS apart” and that NHS as “preferred provider” would provide stability during a time of substantial service delivery change. The private sector has a role he conceded, and he would want to see long term contracts where given, with a distinction drawn between the not-for-profit and for-profit organisations and the same standards expected of all. This would include the private sector being subject to FOIs and being charged a ‘training’ levy.

A “national health entitlement” would be set out so it’s clear what people are eligible for (this is the first time I have heard this articulated) and this would include re-establishing the authority of NICE to get rid of the postcode lottery. We called for something similar in our ‘National Health Guarantee’ in our Going with the Flow report (see above). He emphasised that the National focus should be on what is delivered, and local should be the ‘how’. The health and wellbeing board with the local authority would increase their focus on public health and the wellbeing of their population achieving Sir Michael Marmot’s ‘health equity every policy‘ goal.

The existing financial framework rewards the treatment of illness with no incentive for prevention. Although Andy talked about money and that the Year of Care payment programme for e.g. frail elderly would be the new system for payment, with care in the home incentivised, there was little other detail and nothing on the projected NHS budget deficit.

The whole person care approach would only work if there is an accountable organisation, he said. All local health economies need to create an integrated care organisation. Alongside this there would be a new role for Monitor, they wouldn’t focus on competition but on financial viability of whole health economies. Andy said he wanted to see shared loyalty to local population rather than to the employer’s organisation. There should be a new role for the ambulance service too – less about emergency journeys and more about out-of-hours care. NHS 111 would be re-visioned and beefed up.

Empowering those who give and receive care was the last subject. With fewer providers, bringing social, mental and physical care together, he espoused new rights: a single point of care, single care plan, the right to counselling and therapy and to respite care. The NHS would be involved in training social care staff, with common standards for them and NHS staff.

There was a lot of detail covered, with as much missing, particularly on the financing, even for a transition period during which new models of care are put in place. As with all policy announcements, there is always much detail still to be worked through. No Party can claim the moral high ground on NHS reforms of the past, but at least Andy Burnham seems to be asking the right questions for the future.

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British Heart Foundation and 2020health on the same page

2020health welcomes the latest report published by the British Heart Foundation (BHF) ‘The 21st Century Gingerbread House’. What particularly resonated with us where the two calls to action:

  • • To protect children the UK Government should introduce consistent regulations across all forms of media, which cover all advertising techniques and distinguish between healthy and unhealthy products.
  • • All television advertisements for unhealthy products should be screened after the 9pm watershed.

In our recent report Careless Eating Costs Lives we called for the same action to be obesitythumbnailtaken, highlighting that children have become a particularly common target for junk food advertisements during prime time TV slots (Molloy 2014).  The BHF have previously reported that youngsters who watch family-orientated television shows are being bombarded with up to 11 unhealthy food advertisements every hour. If we take into account the time spent on line, using other media outlets including static advertising, a child’s life is surrounded by advertising of any number of unhealthy foods.  Healthy food messages and the ability to make healthy choices can easily become overwhelmed.

Our findings demonstrate that current legislation bans junk food advertising during children’s programmes, but for many youngsters their viewing peaks around 8pm. Crucially this legislation also does not cover the internet. Online brands can legitimately broadcast adverts to anyone who cares to watch them.  Taking steps to try and regulate online advertising is difficult to enforce and continues to prove challenging, but despite the challenges involved action must be taken.  One of our recommendations was that ‘The ban on advertising of unhealthy foods aimed at children should be extended to day-time TV, from 7am to 9pm.’

Screen Shot 2015-01-14 at 12.11.00We also recognised that just tackling advertising was clearly not enough.  We noted that in neighbourhoods with high densities of fast food outlets (Li et al, 2009 & Pruchno et al, 2014), there is a direct correlation with the increase in consumption of processed food (St Onge et al, 2003). In Tower Hamlets, one of the most deprived boroughs in England, it was found that one in five children (20 percent) was obese and a third overweight. This prompted the council to commission the development of a management framework for managing the number and location of hot-food takeaways.

Building on this and other initiatives we recommended that a licensing procedure should be introduced to control the location of fast food outlets in a local community.  As part of this a health impact and assessment should be made a core component of the development process for town planning.

If we are serious about protecting our children and preventing another generation from the risks of becoming obese we need to bite the bullet.

Blog by Matt James, Senior Researcher at 2020health


References

Li F, Harmer P, Cardinal BJ, Bossworth M, Johnson-Shelton D. 2009. Obesity and the built environment: does density of neighbourhood fast food outlets matter? The science of health promotion. 23(3) 203-9

Molloy, A. 2014. Children being targeted by junk food ads during family television shows, research finds. The Independent. http://www.independent.co.uk/news/uk/home-news/children-being-targeted-by-junk-food-ads-during-family-television-shows-research-finds-9207196.html

Pruchno R, Wilson-Genderson M, Gupta AK. 2014. Neighbourhood food environment in community-dwelling older adults individual and neighbourhood effects. American Journal of Public Health. 104(3): 924-9

St Onge M.P., Keller K.L., Heymfield S.B. 2003. Changes in childhood food consumption patterns: a cause for concern in light of increasing body weights. Am J Clin Nutr. 78: 1068-73

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