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Some thoughts from home - Summit blog 6
24th Apr 2010
Now I’m safely back in London, and the ash has settled, I’ve been mulling over the summit and wanted to jot down a couple of final thoughts. This is, by definition, a very personal blog, because I’m sure each delegate found different things to be memorable and/or interesting.
Of course, this will always be the ‘volcano summit’ for me – but our aim was that for the delegates who made it to the meeting it will have played a minimal role. Only about 20 people were stranded in Europe and the US (and four of them joined by phone), which, out of an initial 110, is pretty good going...although C3’s director, Christine Hancock, was particularly missed!
Highlights? Oh, plenty of them!
1. The Soapbox session worked fantastically – 18 people in all, when we had feared initially that only a handful of people were going to volunteer. A couple of them said that they hadn’t been planning on speaking, but were really swept along by the enthusiasm of the other speakers – surely an indicator of the success of the session!
2. Two of the speakers talked about the ‘environmental gradient’. This concept was new to me – accompanying it was a slide showing a figure pushing a large ball up a steep hill. Reducing the gradient of the slope makes it easier to push the ball (which isn't, in itself, difficult on a flat surface) – and, similarly, healthy lifestyles are so much easier if it isn’t a constant struggle to choose the healthy options.
3. Also important were the many links made between chronic diseases and the three risk factors, and infectious diseases. For example, if you have TB, your body can’t control the disease – Dr Prabhakaran noted that, in a study of male smokers in India, 38% of TB deaths are due to smoking.
4. The talks on Abu Dhabi were also interesting – the Emirati (the local population) are forming a single case study, as the government requires all the local population to be screened for CVD risk factors. A potentially fascinating case study – and let’s hope it makes a difference in a country where obesity and diabetes are so prevalent.
5. Richard Smith and I were keen to encourage people to use new media (I wouldn’t be doing my job if I didn’t remind you about the two online discussions at this point: FutureHealth and development and chronic diseases).
6. There was also a real buzz around the Sydney Resolution – it is clearly being used locally in advocacy, and the offer to have it translated is a great step forward.
7. There was great variety of delegates and speakers – Middle East, South America, China, India...and the developed world – and seeing the similarities and differences in ‘what works’ to prevent chronic disease in each area.
8. I was pleased to see the very positive business involvement in the meeting – particularly the presentation by Discovery and PepsiCo’s soapbox contribution. Companies do influence personal behaviour, all the time, so working with them to move towards healthy products can only be a good thing.
9. Seeing the old and the new so close together was fascinating. Looking out of the window of the hotel, we could see the construction site of a vast new leisure centre – and one of the delegates bemoaned the fact that New Delhi’s plans to green the city are being undermined everywhere in practice.If ever a city needed streets with tree-lined pavements for shade, it's this one (temperatures when we were there were hitting 44 degrees), but green space is apparently constantly being steadily converted to a concrete jungle.
The real highlight of these meetings is always meeting people. This year, in particular, I was very touched by the hospitality that we were offered when it looked possible that I would be marooned in Delhi. My colleague and I were also whisked away for an evening after the summit by one of the hotel’s employees. He drove us into town to see the India Gate, to eat local ice-creams and to have a meal in an excellent restaurant – all were so appreciated, as without that I would not have got to see the city at all, having been stuck inside working for the week! He also taught us a fantastic new word – ‘pax’. It is a contraction of ‘people approximate’ so, for example, the dinner that we held was for ’80 pax’. Why I didn’t have a word for this before, I don’t know!
So, I hope that everyone who attended felt much the same as one delegate who emailed us afterwards to say that it was ‘the best meet on NCDs I have attended in last 25 years of my working in NCDs – very absorbing and highly empowering’. Thank you to everyone who came to the summit, to all who spoke, who helped out, who offered hospitality, and who will now go home and use the ideas and websites that were talked about with such enthusiasm during a very busy, and fascinating, couple of days.
Day 2 – Summit blog 5
21st Apr 2010
The summit is finished! and all without mishap (or, at least, if there was a mishap, it was kept from me – probably wisely). I was doing the job of about four people – and that’s why I’m afraid I didn’t manage to get this written on the day itself... I should add that if this isn’t the most scintillating of descriptions then that won’t be because it wasn’t an interesting day – it’s merely that I find the Muse leaves me when I’ve been averaging less than five hours’ sleep for a few nights!
If you want to read all the presentations, day 2’s slides are here (day 1 is here). I'm to start off talking about me – not because I’m particularly egocentric (although I suppose I do have a blog, so there must be an element of that!), but because if you only read a little bit of this blog, this is the bit that asks for your participation!
At C3, we’ve been working closely with 3FOUR50 to set up two online discussions – one on non-communicable disease and its noticeable omission from the thinking of many development agencies and donors (here), and one on the future of health and healthcare (here). As I said to the delegates, I’ve waited five years for the chance to speak at an OxHA summit and then, like buses, two opportunities come along at once...
The first project, on chronic disease and development, was featured in a session run by Helen Alderson of the World Heart Federation. WHF, along with an international cancer charity (UICC) and the International Diabetes Federation, is working towards persuading the UN to hold a General Assembly Special Session (an UNGASS – pronounced as it’s spelt) on chronic diseases. She showed a slide of the breakdown of official development assistance in 2007, split into different disease categories – glancing at it, I wondered where chronic diseases were... They weren’t. In fact, this isn’t even measured. As Helen pointed out, clearly it’s less than 1% of ODA – which, given the huge toll of chronic disease (8.1 million ‘premature’ deaths (i.e. among the under-60s) in low- and middle-income countries a year), is pretty shocking. Things are looking hopeful for getting the UNGASS, which would be held next year – a very challenging timescale if it is going to be as effectively organised and with such dramatic results as the UNGASS on HIV of a few years ago, that led to the establishment of the Global Fund... I spoke (with notes, alas – hadn’t had time to get it down pat) about the discussion document that I’ve written and posted on 3FOUR50, setting out why it’s a problem that chronic disease isn’t included in the Millennium Development Goals, and why it’s important to think about it now – the MDGs are due to have been achieved by 2015 (they won’t be), and (I think) chronic disease really should be incorporated into whatever takes their place in just five years time. I’m hoping that the document will get people thinking – and I asked all the delegates if they’d be able to take a look and post their thoughts... Please do the same, dear reader! The link is here. I’ve also started to put together a ‘wiki’-style list of ways in which chronic disease impacts all eight of the MDGs, so do have a look at that too (here).
The second project I spoke about was C3’s FutureHealth project, which we put on 3FOUR50 a couple of weeks ago. As I said in my talk, C3 has been involved in several ‘future scenarios’ projects recently – one by PepsiCo, one by the NHS and one by Novo Nordisk – and it seems to be a quite trendy (and, one assumes, useful) idea. However, I haven’t seen any scenarios that have encouraged people to get online and say what they think will happen. So we have put together four themes that might spark some discussion... For me, the most contentious is on ‘weight-loss surgery’ – it’s been shown to be so effective, might it end up being seen as the easy (and cost-effective) solution, and that people don’t worry about getting fat because there’s always the stomach-stapling option? It’s a horrible thought... The other three themes are also beginning to gather some interesting comments, and I hope that the delegates will want to get involved – particularly after another talk by Bo Wesley and Lene Anderson, from Novo Nordisk, who described the process of building scenarios. As a company that specialises in drugs for diabetes – which is predicted to rise steeply over the coming decades – having an idea of the future is essential, and Novo’s two scenarios (one in which obesity is completely normal, and one in which health payments are made principally on the strength of results) map out some possible ways in which health care could look different in 2030.
That’s enough about, er, ‘my’ sessions (do go to the Collaborate section of this website to join the online conversations...) – I’ll tell you about the rest of the day. We kicked off with Ruth Colagiuri talking about the Sydney Resolution, a straightforward, plain-language statement on healthy people, places and planet, that was launched at the OxHA summit in Sydney two years ago, and is being adopted and adapted by many organisations – and it’s also a great advocacy tool, if you want to use it informally. Rakesh Gupta, from the American Cancer Society, has offered to help translate into languages other than English (starting with Hindi), so I’m hopeful that its message will spread even more widely. Oh, and Ruth had some great visual slides, including one of an advert from Humble oil (later became Exxon) in a 1962 edition of Life magazine: ‘each day Humble supplies enough energy to melt 7 million tons of glacier’! And that, remember, was a good thing...
Next were two presentations about chronic disease in Latin America. First, Manuel Ramirez talked about a nine-country study on chronic disease that pointed up the differences in approach across the region – Arun Chockalingam asked if the governments are going to come together (as has happened in the Caribbean) to address the issue, and apparently there is already the suggestion of a presidential summit of the nine countries. That is the point at which things could really start to happen! Beatriz Champagne spoke about the success of smokefree legislation (Latin America leads the world on this), but how obesity is high, and growing – 31% in Mexico City, 26.6% in Santiago, for example. She is working on a Community Interventions for Health project in Mexico City – she pointed out that connections between different places (e.g. gyms, healthcare centres and schools) may not be made, even where they are all situated in close proximity. Making use of what facilities are available is essential.
At the summit in Cape Town a couple of years ago, we had a ‘Soapbox’ session – and we ran one again this year. We were initially worried that the hour scheduled for it was too much time – given that each person has only three minutes and we had only about six people express an interest in advance, we thought it could prove to have been a mistake to hold it. But in fact, people really took to the idea – about 15 people ended up speaking, and it was lively, and fun, and brilliantly chaired by Richard, who (after the allotted time) would begin clapping loudly, even if the speaker was in mid-sentence. A very fair system!
After lunch, I’m afraid I didn’t get a chance to listen to the comparison of surgery, the polypill and community interventions, but what little I did hear sounded fascinating. Is the polypill, like weight-loss surgery, going to lull people into a false sense of security about being able to lead unhealthy lives, on the assumption that they can then be medicalised and, in effect, fixed...?
The final session was led by Derek Yach, the SVP (which I always read as ‘s’il vous plaît’ on first glance) of global health policy at PepsiCo and a C3 Board member. It was an introduction to, and discussion about, a new report by the Institute of Medicine, on cardiovascular disease in the developing world. There were three respondents, who explained how the 12 recommendations of the report are being, or could be, implemented in their countries and regions (Abu Dhabi, the US/Mexico border and Bangladesh). Arun Chockalingam, the new director of global health at the NHLBI, made it very clear that his organisation, which sponsored the report, will be taking the findings very seriously. As he said, this will involve working with a wide range of partners because, ‘without you, we are nothing’.
That, for me, sums up the meeting – it’s been a pleasure meeting new people, seeing connections being made, and listening to the fabulous and very diverse work that has been being done all around the world. It was worth all the effort, without any doubt at all. Thanks, in particular, to my colleague Hester, to Richard Smith, and to Dr Prabhakaran, Suma and their team – let’s face it, if any one of us hadn’t been here, it would have been a very different experience for everyone!
And now? No sightseeing for me, because I have to try to work out how the heck I’m going to get home. Please keep your fingers crossed for me – if VS300 leaves London tonight bound for Delhi, there’s a chance I might be on the return flight. If not, I will be stuck here until May (and of course the airline won’t pay accommodation)... Having said that, Indian hospitality is renowned, and I am grateful for the offers of help already received from Delhi delegates – thank you! And watch this space...
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Most recent comment by Richard Smith on 24th Apr 2010
Day 1 – Summit blog 4
20th Apr 2010
It’s nearly 1am and it’s been a crazily busy day, but I can’t turn in without blogging (this is worryingly addictive...). This is my fifth OxHA summit, and they are always a good place to hear about plenty of different forms of research and action on diet, smoking and exercise. Sure enough, today presented us with some pretty horrific statistics on the extent of chronic disease, particularly in India and China, but also some really inspiring examples of practical things that can be done, particularly from an insurance company in South Africa, and from Victor Matsudo, who leads the Agita programme in Brazil and elsewhere, that aims to get people moving for 30 minutes a day... As someone commented to me afterwards, one of the best things about the day was that it was really focusing on what can work and (as the theme of the summit indicates) make a difference.The day was chaired by Nikhil Tandon and Richard Smith (who bounded around with impressive energy, given the early start time). We kicked off with a couple of introductory videos from the directors of C3 (my boss, Christine Hancock) and OxHA, both of whom are stuck in London courtesy of the ash. The first presentation in the room was by the co-host of the summit, Dr Prabhakaran, and, for me, the most memorable part of his talk and accompanying video were about smoking. In India, many smoke bidis, which are cheap local cigarettes (often, and erroneously, seen as ‘natural’): women who smoke bidis lose 8 years of life on average; men lose 6 years (and 10 if they smoke). In India, apparently 15% of smokers die between the ages of 30 and 49, but only 8% of non-smokers – taking a huge bite out of the working population.
I’ve often heard about the differences in physiology between Caucasians and people from south Asia, and Prabhakaran has a very illustrative slide of two men with similar BMI (about 23 – in the normal range). However, the body fat percentage of the westerner was 9.1%, compared to 22% in the south Asian – a huge difference, with potentially damaging health consequences.
Next up was Scott Ratzan from Johnson & Johnson, a longstanding OxHA supporter. He presented the idea of ‘health literacy’, and focused on the importance of the mobile phone in communicating about health (there are 50 million new phones a month in India (more people have them than are online). One example of a project using mobile technology is BabyCentre , which reaches 500,000 pregnant women a month in India through text messages and emails – it’s very helpful to know what should be happening at each stage of pregnancy.
Abu Dhabi finds itself undertaking a huge health experiment, as Oliver Harrison outlined. The relatively small population of 2.1 million people has access to huge wealth, and a highly strategic and focused government – and consequently expectations for health are sky-high. As Oliver put it, if you can’t sort out health here, you should pack up and go home! The country is, in effect, a prospective cohort – it is a unique opportunity and, for people who are into stats and trials, it’s a dream: 97% of Emirati adults have now had a health screening – making it the largest Framingham cohort in the world. And the statistics are worrying – 34% of Emirati adults are overweight and on top of that, 36% are obese; 21% have evidence of diabetes, and another 10–12% have impaired glucose tolerance (an early-warning sign for diabetes)...
The next presentation was our first experiment with patching in speakers by phone. Paul Sacher of MEND (Mind, Exercise, Nutrition, Do It!) gamely took on the task of calling in to a speakerphone on the podium, next to which we positioned a microphone so that everyone in the room could hear him. We clicked through his slides as he spoke – and it worked like a charm! And, happily, not only was the talk audible, it was also interesting – MEND is a project for overweight children, demonstrating some great results – an 80% attendance rate (which is very promising given it’s an intense programme over 10 weeks), and BMI among the children participating was reduced by 0.8 units; waist by 2.7cm; and they take on average 4 hours more physical activity a week. Even more encouragingly, it tends to be sustained over the coming months. However, despite MEND’s 319 sites, it can currently only reach 1% of the UK’s overweight children – there is so much more that can and should be done where projects like this can be further scaled up and rolled out!
The next presentation, by Victor Matsudo, was unquestionably the most fun of the day. The pre-lunch slot is always a tough one for people who are probably jetlagged and hungry, but he energised us by getting everyone to wave balloons around and generally get ourselves moving (I’ve posted a photo – not great I’m afraid, but you get the idea). The balloons had been hastily requested from the hotel this morning – they obliged, even if they were unusually tiny and extremely hard to blow up...
Victor’s key message, and the message of the Agita programme, is that ’30 minutes makes a difference’ (I saw him in the gym yesterday – he walks the talk). He also made the very important point that physical activity needn’t be about working out – it can be built into everyday life, including, as he put it, walking the dog... or even walking your mother-in-law (after all, ‘if there’s one thing worse than a mother-in-law, it’s a mother-in-law who’s sick!’). And when asked what the best sort of exercise is, he noted that the best physical activity is what you like, and what is feasible. Sound advice indeed: it’s certainly what’s worked for me over the last few months (I’ve lost over a stone, seeing as you ask).
After an update about the Global Alliance for Chronic Disease by Cristina Rabadan-Diehl, we were all gripped by an extremely interesting presentation from Greg Morris, of Discovery, a South African insurance company. I know that having ‘interesting’ and ‘insurance’ in the same sentence sounds like a contradiction in terms, but Discovery’s incentives scheme, Vitality, is showing that it can engineer some really impressive behaviour change. The programme rewards healthy behaviour by its customers – some rewards are cheap and frequent (such as providing discounts on cinema tickets) or much bigger but more occasional rewards (such as discounts on flight with low-cost airline Kulula – 1 in 4 flights with the airline in the country are now linked with Discovery customers).
This is a real example of a win–win: the individual gets the discounts, and Vitality gains in terms of the payouts it makes for ill-health. The programme to encourage healthier living demonstrably reduces hospitalisations – and if you are fit, you also make a better patient, with admission rates 9.6% lower in highly active individuals than among those who are inactive, and their stays in hospital are also half a day shorter. This translates into some really serious cost savings for the company – as well as better health for the individual.
As Greg put it, ‘there is no question here that commercial incentives are changing behaviour’.
Next up were two presentations on China – one focusing on urban and one on rural parts of the country. We were treated to some information on the brand new China Rural Health Initiative, as well as the Community Interventions for Health project in Hangzhou province. Recently, an article claimed that China has become the diabetes capital of the world – this was questioned today (India probably still pips them to the post for this dubious honour), but it’s undeniable that diabetes is a large and growing problem.
The final presentation in the room was from Chris Walker, who works for a project on the US/northern Mexico border. And the statistics here were scary, too: 88% of the deaths in this border region are due to NCDs, and 70% of population of northern Mexico is overweight or obese. But much is being done, particularly by promotoras – local community health workers.
Finally, Eddie McCaffrey (via a short video from London, which spent last night downloading itself at snail’s pace onto my laptop) talked about the importance of new media in the new millennium. In particular, he went through the benefits of 3FOUR50 as a tool for sharing ideas – and, potentially, for sharing stories, which he says are ‘part of our DNA’. Stories are personal, and interesting – and he encouraged delegates to sign up on the site to agree to be part of a proposed 3FOUR50 ‘audit’, with the ultimate aim of putting together a million stories from all around the world.
Richard Smith closed the day’s proceedings, noting that we, as chronic disease experts, aren’t yet getting our voice heard. The world doesn’t care – so we need to be more innovative in how we spread our messages, and 3FOUR50 is one way of doing this.
I’m particularly glad he and Eddie have highlighted this so strongly, because both my presentations tomorrow are about projects on 3FOUR50. I’m hoping that the case has been made: delegates will already be thinking that they should go online and use the tools on the site, and tomorrow I get to explain to everyone just how easy it is to do! Of course, I should have spent today refining my presentations – but if I had, we wouldn’t have got hold of the balloons, and the website wouldn’t be nearly so up to date....
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Most recent comment by Tony Harrison on 21st Apr 2010
'Innovate, collaborate...' - Summit blog 3
17th Apr 2010
Turns out that staying up until 3am watching the UK political party leaders’ debate on TV on my first night here was not conducive to overcoming jet-lag, and today has been particularly hectic (certainly not the sightseeing trip that I’d been angling for...).
The theme of the summit this year is ‘Innovate, collaborate, make a difference’ – and it’s fair to say that we have spent most of today doing a LOT of innovating and collaborating. Fortunately, we are reasonably adept at using ‘new media’ (social networking, video, skype,...), and this flexibility is really coming into its own as volcanic ash wreaks havoc with the travel plans of some of the OxHA delegates. It may all be a monumental hassle for me and my colleague, but in fact remarkably few people have had to drop out altogether – and of course the glories of the internet mean that slides and videos can wing their way over to us, even if their presenters can’t.
In the absence of both the director of the Oxford Health Alliance and my boss, we’ve co-opted a new chairman, Richard Smith (director of the UHC Chronic Disease Initiative), who arrived this afternoon. It turns out he was at a conference just after 9/11, when all the planes were similarly grounded, and he seems to have survived that experience – sure enough, half an hour (and a rejigged agenda) later, and all seems on track.
Needless to say, I’ve not even thought about the presentation I’m giving on Tuesday. As they say, ‘work expands to fill the time available’. At this rate, that’ll be for about 30 seconds at 11:29 on Tuesday morning...
Low point of the day? About 4km into my run in the gym, when I thought my legs were about to give way beneath me, the result of a day’s ossification sitting behind a desk.
Highlight of the day? Undoubtedly, an item on the pudding menu at dinner: ‘Peach cream-filled Wind Bags'.
So – a packed, calorie-laden and surprisingly successful day, albeit not one with a huge amount to tell. I’m assuming, for example, that you don’t want to know about the trials of trying to set up some form of web-conferencing? No, of course not – that would turn this into One Of Those Blogs, the sort that makes me want to scream ‘NO ONE IS INTERESTED!’ at the author. So I’ll see you tomorrow.
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Most recent comment by Sara Karrar on 19th Apr 2010
Two worlds - Summit blog 2
16th Apr 2010
Last night, at dinner, I was sitting in a restaurant on the sixth floor of the hotel, with a spectacular view of an eight-lane road, huge new toll booths and hundreds of winking car lights. Not, you would think, the most prepossessing of vistas – but it turned out to be an extraordinary example of the ways in which the ‘old’ India exists cheek-by-jowl with the ‘new’. Chugging alongside the shiny new speedy BMWs and HGVs were often-headlight-less tuk-tuks, scooters and cyclists, and pedestrians trying to dodge the vehicles to cross the carriageway, which has doubtless cut communities in two. Several times I found myself unable to look away from what I was sure was about to be a horrific accident – cars reversing along what would be the hard shoulder (if there was one), back towards what would appear to be a very-well-hidden exit... Somehow, everyone coming up behind them managed to get out of the way, but I’m sure that is not always the case. The terrible extent of road-traffic deaths in this country – over 100,000 each year – suddenly looks entirely explicable.
But the question is: how do we create an India where not only the roads are safer for cars, but where cyclists and pedestrians are not second-class citizens? And, come to that, how do we achieve safer roads for non-car users in so-called developed countries? London (although rarely the scene of quite such novel driving) is hardly a haven for cyclists, as I have mentioned more than once in this blog.
Summit preparations continue apace, although we have had to rethink the odd session and are considering video links and filmed interviews with a few of the people stranded on the other side of the world by Eyjafjallajokull’s bad temper. Thanks to the glories of Skype and email (and a mercifully fast wireless connection in the hotel), everyone has stayed in touch and in good humour. With many of our delegates’ travel plans unaffected, and many others who either live in the locality or who arrived early to do some sightseeing, there is every reason to expect that the meeting will be just as much fun and thought-provoking as in previous years.
In any case, as one of my friends back home in Blighty put it today: ‘I'm sure the Blitz spirit and gallows humour will get you through. Oh, and the tropical conditions and a pool.’
Ahead of the ash! - Summit blog 1
15th Apr 2010
The Indian capital, New Delhi, has been a poster-child for the spread of urbanisation and lifestyle change over recent years – making it a particularly appropriate venue for the 2010 Oxford Health Alliance Summit. At C3, we have been organising the event for months. Venue, theme, invitations, speakers, menus, agenda, website: you name it, we’ve discussed it. In fact, pretty much the only thing we failed to factor into our thinking was a contingency plan in the event of volcano-related airspace closure [cue chaos back home under a giant ash shroud]. There comes a point where all you can do is raise your eyes to the heavens and say “good luck” to those trying to get here from – or through – northern Europe... I’m sure we’ll see you soon!
Having arrived early this morning, I can report that the hotel has plenty of opportunity for delegates to practise what they preach about healthy lifestyles: my colleague and I have been for a run in the gym, tried the pool, and been to see the meeting room, which is large, with plenty of natural light. However, I have yet to locate stairs instead of the omnipresent lifts – and I feel distinctly uneasy about the ostentatious waterfalls in the lobby (not to mention the extraordinarily capacious baths), given the aridity of the surrounding countryside. Delhi is currently really, really hot, and I’m not just saying that because I have just emerged from an unusually hard English winter: temperatures here are peaking at about 43°C (almost 110°F). People here know that they are living climate change.
But back to the summit. The sessions we have planned are intriguing, and I will blog about this in the coming days. But, for me, one of the most important parts of these annual gatherings is something that will never make it on to an agenda – namely, the chance for delegates to meet people who are from very different fields but who share a common passion: the eradication of preventable chronic disease. Previous meetings have led to research projects, articles and practical action on making it easier to be healthy. My hope is that the 100+ delegates – who will be arriving soon from over 20 countries, plate-tectonics permitting – will make connections that they would not otherwise have made, and that projects dreamt up here will have a real impact on the lives of people in communities all over the world.
‘Wellness’ in practice
20th Nov 2009
Although I regularly talk about workplace health and encourage companies to take their employees’ wellbeing seriously, until very recently I hadn’t had a chance to experience a workplace health programme myself. However, in October I spent a half-day at the Walkers factory site in Leicester, in a group of about 12 (including drivers, admin staff and others), at a session run by a health company, Lovely & Healthy. It was eye-opening and – somewhat to my surprise – a lot of fun.
First, we rather nervously sat through a short and hard-hitting video about heart health, showing a man having a heart attack in his late 40s – a very effective way of getting everyone there to sit up and take notice!
This was followed by a talk about various health issues – nutrition (including salt, alcohol etc.), exercise, smoking and stress (including dealing with night shifts).The approach taken was that we need to focus on balance – i.e. no one can be 100% healthy all the time, but that the bad things we do to ourselves (such as drinking too much) need to be countered by healthy actions.
I was impressed by the level of health knowledge that many of the participants demonstrated – although later one of the instructors said to me that it was an unusually knowledgeable group and also that, of course, the difficult part is getting people to act on what they know! Some of the very smart questions asked included:
• You’re recommending eating plenty of wholegrain foods including bread – but isn’t bread very salty?
• We know it’s ‘five a day’ for adults – but is it the same for children?
The final part of the day was a 90-minute session of games and exercises, which really brought out my competitive streak, I’m afraid... It included a throwing game (in which I came second, much to the relief of the man who beat me by one point), a 1.5 km bike-machine race that I’m pleased to say that I won (quite right too, given the amount of cycling I do in London!), some balance games, and make-your-own-smoothie. (Top tip: use frozen berries instead of ice to make it cold.)
An optional part of the day was a short ‘health check’ (this is both confidential and voluntary) – including measuring BMI, blood pressure, cholesterol, percentage fat, hydration and heart rate. I found this very useful – although of course my stats were not added to the (anonymised) database as I am not part of the workforce.
Finally, we were all asked to write on a post-it note one behaviour change that we would make, and stick it on the wall, joining at least 100 other post-it notes. These were quite varied – but it was interesting that a high proportion of the post-its said that the change would begin from ‘tomorrow’, rather than today! (Mine, if you’re wondering, was to bike to work at least twice a week for the whole winter. So far, so good...)
Happy 60th birthday, Human Rights!
10th Dec 2008
On 10 December 1948, the United Nations adopted the first international statement on human rights, the Universal Declaration on Human Rights, which was compiled to prevent any reoccurrence of the carnage of the Second World War. But in our 21st-century, warming, unequal and unhealthy world, human rights are as relevant and as important as they have ever been.
If you’ve never really thought about the importance of human rights for health and health promotion, you’re not alone: a Lancet editorial this week, in an issue celebrating the anniversary, bemoans the ‘general lack of understanding about what the right to health is and what it means in practice’. It is a ‘legal instrument – a crucial and constructive tool for the health sector to provide the best care for patients and to hold national governments, and the international community, to account’.
While we don’t have the ‘right to be healthy’ (no government could guarantee that!), we do have the right to the ‘best available standard of physical and mental health’ and for this to be provided without discrimination. There are other rights relevant to health, too, that go beyond the health sector. For example, the rights to accurate information (we can’t make decisions about our health without an awareness of the repercussions of unhealthy eating, or smoking), to education (e.g. families may feel they have no choice but to take girls out of school to care for sick relatives), and the right to take advantage of scientific progress (say, smoking-cessation innovation).
(If you’re interested in reading more about this, there’s a short introduction to human rights and health here - or check out the Lancet.)
Crunching workplace health?
31st Oct 2008
The organisers of the Enterprise for Health conference, where I just spent two very interesting days, could hardly have predicted when they organised the meeting that the two phrases on everyone’s lips by the end of October would be ‘credit crunch’ and ‘banking crisis’ – but it certainly made for interesting discussion. Professor Cary Cooper, for example, made the very pertinent point that sickness absence (often used as the main indicator of ‘health’ in the workplace) is likely to fall in a recession, as job insecurity rises and we all become increasingly desperate to give a good impression at work. In tandem, ‘presenteeism’ (people turning up for work when they really should be taking the day off for illness) will rise – and this is a notoriously difficult concept to define, never mind quantify.
Now, more than ever, it is important for businesses to invest in the wellbeing of their workforce – helping those who are currently fit and healthy stay well.
For me the real star of the show was the building in which the conference was held, GlaxoSmithKline’s West London headquarters (a familiar sight to anyone who uses the M4 motorway flyover). Inside, the building is a case study of a holistic approach to health at work – well-populated cafes selling fresh foods, even trees in the five-storey-high central atrium. The whole building seems lit by natural light. For me, as a cyclist, what particularly delighted me was that not only does GSK provide bike storage facilities and showers, but there is an actual bike shop on the premises! Thanks to GSK staff, there is photographic evidence of this: click here ...
A logic problem?
27th Aug 2008
I’ve just got back from a talk by Andrew Lansley (click here for an article about it in The Guardian), the Conservative shadow health secretary in the UK, on the Tory plans for public health after the next election ... working on the assumption, of course, that they win! I’d been beginning to wonder – along with many in this country – where the differences lie between Tories and Labour: are they really morphing into one another in their desperate scrabbling for the hallowed ‘middle ground’?
On this morning’s showing, there are still significant differences. In fact, I’m still trying to get my head around what seemed to me to be a logical gap in the thinking that was presented. Much of what he said was entirely uncontroversial, indeed sensible. The Tories are planning to separate out public health funding from health funding more generally – thereby preventing the ongoing issue that public health budgets tend to be the first to be cut and money siphoned off elsewhere. Apparently, since 1997 (when Labour came to power) public health staffing has decreased by 5% in the UK, as NHS staffing has increased by 25%. He spoke of the importance of involving industry in the solutions, of local empowerment, of providing a way for SMEs to access occupational health (wellness) for their employees.
Importantly, he also spoke eloquently about the impact of social inequalities on health – poverty, unemployment, social breakdown in cities.
However, he then turned to the language of public health (notably obesity). He claims that the Foresight report has made a fundamental error in terminology – namely that, by blaming the ‘obesogenic environment’ for the rise in obesity, it removes any responsibility that might otherwise accrue to the individual. In other words, I always have an excuse: it’s not my fault.
What I didn’t – and don’t – understand is how the two halves of his talk can be consistent. On the one hand, public health is all to do with overcoming poverty. On the other hand, the individual has to take responsibility and not blame the circumstances in which they live.
What was lacking, to me, was how to square the circle. To do that, don’t you first have to get rid of the poverty and other inequalities that affect health, and only then can you say that the individual is fully responsible?
Of course, I’m not suggesting that this is never about the individual. It’s my fault I’m overweight, for example: I don’t get enough exercise, though I could afford to go to a gym, ride my bike more, or reach my 10,000 steps a day; I eat too much, given how little exercise I take; and I probably drink more than is good for my weight, never mind my liver. I take responsibility for this – I kick myself on a daily basis, and I’ll join a gym next week...
But what if I couldn’t afford to eat fresh food and take exercise, and I’d got addicted to nicotine when I was still a child? These are the people who haven’t been empowered to take responsibility, and I would be unhappy to see them accused of using ‘excuses’ based on the social circumstances in which they live, given that they have no power to change that (obesogenic) environment.
Big money for bikes in Britain
12th Dec 2007
Congratulations to Sustrans' Connect2 project, which has just won a staggering £50 million, following a national public vote in the 'People's Lottery'. It beat three other schemes (including an extension of the Eden Project in Cornwall), winning 42% of the vote. The funding will be spent on building and improving cycling/walking routes around the country - including new bridges and tunnels, and reclaiming old railway lines etc. An estimated 79 communities will benefit - including Bermondsey in South London, near where I live (and bike!).
You can read more about the project on the Sustrans website, here. The project is expected to cost £140 million in total, but this money is a fabulous kickstart for an excellent initiative. It's great news for healthy and sustainable travel in the UK!
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Most recent comment by Karen Siegel on 14th Dec 2007
How should we talk to environmentalists?
9th Nov 2007
I’ve been lucky enough to go to two interesting – and very different – conferences in London this week. The first, 'Environmental Futures 07: Adapting to Change', looked at the effects of climate change. The second was a conference of the Association for the Study of Obesity: ‘Tackling obesities: future choices’. What struck me was that the attendees at the obesity conference appreciated the importance of the environment to lifestyle risk factors and health – but the environmental conference saw the link to health almost exclusively in terms of heatstroke, flooding problems, the spread of diseases such as malaria and bluetongue, etc.
So, we could be latching on to the overlap between environmental issues and public health much more, to persuade the delegates at ‘Environmental Futures 07’ (and elsewhere) that chronic diseases are hugely impacted upon by the environment in which we live. Linking strongly with environmentalists will work to strengthen both cases: the health case and the environmental case. Let’s shout about this (and not just at the Oxford Health Alliance summit in February, which will look at these issues)!
I’d be delighted if 3FOUR50 members would provide input about the different ways that we can link existing environmental concerns to issues around chronic disease. Here are a few to get us started:
1. We are all worried about the impact of increasing car use on emissions. But we should also be saying that encouraging cycling instead of car use will increase physical activity.
2. High air pollution is bad for the environment – and leads to increased heart disease.
3. Allowing the asphalting-over of parks and other outside spaces will increase runoff and lead to flooding. But we should also be saying that tarmac-ed spaces replacing green space could act as a deterrent to stop children (and adults) from running about and getting exercise.
Tell us more!
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Most recent comment by Katy Cooper on 22nd Apr 2009
WorkFit – BT’s latest employee health scheme
23rd Oct 2007
I haven’t been blogging for a while – but today I am inspired to do so, having just got back from an event by a company that is one of the most progressive when it comes to health in the workplace.
From what I have seen today, BT (formerly British Telecom) seems to be fully embracing the importance of the word ‘health’ in ‘health and safety’ – the company’s WorkFit campaign addresses both the need to look after employees who are ill, and also the importance of prevention of disease. WorkFit has, to date, covered mental health, smoking cessation, obesity issues (encouraging employees to lose weight, through a combination of online tools and practical help – those taking part lost an average of over 2 kilos) and – launched today – ‘Cancer and You’.
Each part of WorkFit has been delivered in partnership with NGOs (currently, with CancerBackup) and with the unions. Union involvement is seen as critical, as it ensures that the scheme is not seen by employees as merely the bosses trying to force them into changing lifestyles.
The launch event this morning included brief talks from the under-secretary of state for health, Ann Keen, and the chief medical officer at BT, Paul Litchfield. So far, so not-very-different – but BT had also set up a ‘Lifeworks zone’ to publicise the new WorkFit campaign, and encourage everyone in the building to take part. In the atrium, BT employees played table football with one another, ate fruit, played a ‘Bash the ash’ game (I’m afraid that would take too long to explain!), and even designed bras, using a variety of collage-y materials… All good fun...
But underpinning it all is a serious message: at any one time, around 100 BT employees (out of a workforce of around 100,000) will be off work with cancer. We heard stories from three of these people, who have been diagnosed, and treated, for cancer while working for the company – putting faces to the statistics. As the chairman of the BT Group, Sir Michael Rake, pointed out, over 30% of cancers are preventable by leading a healthy lifestyle – and BT is clearly taking active steps to encourage this.
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3FOUR50 is keen to showcase what companies are doing – both in terms of best-practice that can act as an example to other companies, and also in terms of the actual results, where companies have had the foresight to measure the impact of the schemes. If you have a workplace health scheme that you would like to tell 3FOUR50 about, do register 3FOUR50 and blog or post photos on it, or 3FOUR50 can also post it as a showcase.
Get healthy? Get singing!
30th Aug 2007
Not content with just the one job in chronic disease prevention, I also have a respectable second career as a professional choral singer. I have been singing regularly since I was seven – it’s relaxing, sociable and thoroughly enjoyable. And now I read that it can have positive health benefits, too... This didn't really come as a surprise to me – after all, singing is fantastic for breath control and fitness, not to mention restoring mental equilibrium after a hard day at work – but it is good to see that research is being done into its health effects. The Sidney De Haan Research Centre for Arts and Health in Canterbury is trumpeting the link of singing to health and wellbeing, particularly for children and older people, and for those who might otherwise be socially excluded.
Following the lead of ‘exercise on prescription’, ‘The Centre is committed to providing a convincing rationale for “Singing on Prescription”, and developing a practical scheme that can be tested for its effectiveness through controlled evaluation.’
What a fantastic health-promotion idea!
Cycling lunacy?
17th Jul 2007
I'd be really interested to hear any comments you have about an email sent recently by a UK engineering firm to all its employees, banning them from cycling on company business. The peculiar irony is that the company, Jacobs Babtie, has been advising local authorities - including Oxfordshire County Council and Transport for London - on improving sustainability of transport schemes.
My personal opinion is patently obvious from the title to this blog, but just to make it really clear:
1) Places of work should be encouraging, not discouraging, of physical activity - providing showers and bike racks, for example. Here, members of parliament who cycle are given a travel allowance - why don't more employers do that? It’s cheaper than subsidising a company car....
2) Jacobs Babtie should be practising what it preaches. If the company doesn't think it's safe, that is a pretty clear indication that it is failing to ensure that its transport advice is acted upon sufficiently by local authorities.
3) We don't need nannying, thank you very much - either by the state or by employers. By all means, hand out safety literature and go to the effort of alerting employees to cycle routes - but beyond that, trust cyclists to behave in the best interests of themselves and other road users.
4) The Times (the first place where I read about this, but it's got quite a bit of coverage - click here >>) cites a study from the US that says that people who cycle regularly beyond their mid-30s live on average two years longer. OK, there will be differences depending on the environment within which cycling takes place - but in that case see point 2) above!
Cycling is good for you, good for the environment and good fun.
Three cheers for smokefree England!
2nd Jul 2007
At long last, the law banning smoking in enclosed public places has come into force in England, bringing us into line with other parts of the UK. Yesterday - the first day of the ban - I went to The Cock pub in central London, an occasional post-church haunt of mine on a Sunday lunchtime. And lo! where once there had been clouds of disgusting cigarette smoke, there was instead a sticker on the door warning patrons that It Is Illegal To Smoke On These Premises, and inside ... well, for starters I could see across the room unimpeded, which has to be an improvement, and of course I didn't walk out stinking of smoke.
When it came to it, I didn't stay inside the pub for long, because one of my friends still smokes and wanted to sit outside (for once, it wasn't raining). It's actually good planning by someone in government that the ban has come into force during what passes for summer in this country, so we have a few months in which to sit outside while the smokers become accustomed to not being able to go inside and light up. Then it'll get colder and wetter (if that's possible), and they'll have to choose between socialising and smoking....but I'm hoping that by then many of them will have kicked the habit...
It's World No Tobacco Day!
31st May 2007
Today, 31 May, is World No Tobacco Day, which this year is focusing particularly on smoke-free environments. Here in England, there is - thankfully - only one month to go before legislation at long last comes into force banning smoking in all enclosed public places. As a professional singer, I can hardly wait for the ban! How wonderful it will be to be able to go out for an evening and not leave with a sore throat from the smoke, and with clothes stinking of someone else's poisonous habit...
According to the World Health Organisation, passive smoking - or 'secondhand smoke', as it is often now called - causes at least 200,000 deaths a year globally in workplaces alone (14% of all work-related deaths caused by disease; many of those affected work in the restaurant, entertainment and service sectors) and 2.8% of all lung cancers. That is shocking.
Roll on 1 July - we need smoke-free legislation in England, and we need it now!
You can read more about World No Tobacco Day at http://www.who.int/tobacco/
Cycling in London - love it or hate it?
25th May 2007
I love cycling - I was almost born on a bike - but cycling in London is so frustrating! It's been lovely and sunny for the last few days, with light winds, just perfect for getting from A to B quickly and easily under one's own steam, without having to brave the crowded rush-hour tube.... But wait! there are a few - er - obstacles that detract a tad from the enjoyment of the experience:
1. Bendy buses. They have a fatal flaw - they bend. Specially designed so that those behind the wheel can't see round the corner of the vehicle, and fail to see cyclists who are overtaking. Not the fault of the drivers per se, but a bit more caution on their part wouldn't go amiss...and whoever designed them should be made to cycle through central London every day for eternity as penance.
2. Pedestrians. They step out without looking. All the time. Especially when they are on mobile phones, or when they are shopping on Oxford Street. And then I have to swing out of their way, straight into the path of the white van coming up behind me...
3. Other cyclists. Not all of them - some of them are lovely (quite a little fraternity we've got going here). But I do find it irritating when they all jump red lights. (Having said that, there was an interesting piece of research the other day that suggested that women are less likely to jump red lights and therefore MORE likely to be involved in an accident, as the most dangerous point is the moment that the lights change and the surrounding traffic roars off. Go figure. Life's not fair.)
4. Buses. All buses. They cut you up. They may not mean to, but they do.
5. Delivery vehicles. Their drivers park in cycle lanes, open doors without looking, swear at cyclists, stub their cigarettes out the window without looking, etc. etc.
6. Taxis. Cab drivers make a habit of pulling sharply into cycle lanes when picking up a fare, and have a tendency to perform unexpected U-turns without indicating first.
7. Pollution. My optician tells me that it's having a deleterious effect on my eyes. I know. I can feel it.
8. Cycle lanes with a kerb on both sides. This might sound like the ideal solution, as motor vehicles don't trespass into the space... but in practice it means that if a pedestrian steps out, you can't swerve to avoid them without actually hitting the kerb and coming flying off the bike. Ouch.
(I'll post some photos of my bike journey to work one of these days.)
But hey, it keeps me fit and there's a great sense of achievement in arriving at the office still in one piece!
If you feel like commenting on this blog, how about telling me the worst place in London for cycling? My personal anti-favourite is Oxford Street - lots of tourists looking the wrong way before stepping out... Or add to the list of pet peevs.... ;-)
NGO Forum on tackling obesity
12th Feb 2007
My first blog… I should confess to a little apprehension around this, but there again, nothing ventured etc!
So why start now? Well, last week I went to a very interesting meeting of health professionals, NGOs and UK government officials, who met under the banner of the ‘NGO Forum’ to discuss Tackling the social determinants of obesity: why weight? The keynote speaker was Michael Marmot, who is particularly knowledgeable about inequalities in health (one of his many hats is as the chair of the WHO Commission of Social Determinants of Health - http://www.who.int/social_determinants/en/).
His engaging and unusually witty lecture focused on the extraordinary range of different drivers of obesity, above and beyond the simple ‘energy in / energy out’ equation – that material circumstances and empowerment are also important for health. He used some striking examples – in Russia, for example, since the end of Communism life expectancy has risen for those who are university educated, but fallen for those with just an elementary-level education. And life expectancy is not strongly related to wealth – Cuba’s life expectancy is now above that of the USA, even tho’ its per capita GDP is far below that of the US.
Fascinating stuff – and he concluded that tackling obesity requires:
a) a whole-of-government approach
b) keeping (in)equalities at the forefront.
Christine Hancock, the European Director at OxHA (that’s the Oxford Health Alliance, www.oxha.org, for the uninitiated), was on a panel of experts answering questions from the floor on a whole range of determinants of health – food labelling, on the physical environment, on social marketing, workplace health, and so on.
Particularly strong feelings were in evidence around whether or not the food industry should be engaged in discussions around obesity – are they solely part of the problem, or can they be part of the solution? Seems to me that there is a long way to go, but we certainly can’t leave them out of the conversation altogether…