Individual responsibility for health and self-care are key themes in recent health policy development in England. The King’s Fund have addressed the issue with three papers:

• Paying the Patient: Improving health using financial incentives identifies programmes based on both positive and negative incentives, finds that financial incentives are effective in encouraging people to perform clearly defined, time-limited, simple behavioural tasks, and also in encouraging participation in lifestyle programmes.However, healthier behaviour is not maintained and financial incentives are not effective when the behaviour change required is complex, for example, giving up smoking.
• Low-income Groups and Behaviour Change Interventions: A review of intervention content and effectiveness considers interventions targeted specifically at low-income groups, this paper asks which interventions are effective in getting people to quit smoking, eat healthily and exercise. It reveals that the most frequently used techniques are providing information and encouraging people to set goals, which can be particularly effective at changing behaviour in disadvantaged groups.
• Using Information to Promote Healthy Behaviours looks at the theory and selected evidence of interventions in practice, and what this can tell us about the role of information in behaviour change programmes. Information-based health campaigns are a major part of the government’s health promotion strategy. A £75 million marketing programme has recently been announced to encourage healthy behaviour in children. This paper looks at the theory and selected evidence of interventions in practice, and what this can tell us about the role of information in behaviour change programmes.

Two more papers are due in the Kicking Bad Habits series before a final report is drafted.

More than one in four adults admitted to hospitals, care homes or mental health units are suffering from malnutrition, the Nutrition Screening Survey and Audit of Adults on Admission to Hospitals, Care Homes and Mental Health Units has found. Women and the elderly were at greatest risk, says the report from the British Association for Parenteral and Enteral Nutrition (Bapen). More than 11,000 patients were screened for signs of being under-fed and 28 per cent were found to be malnourished.

It recommends:

• Screening should be undertaken in all institutions and repeated at interval according to care setting, using accurate and reliable instruments
• Results of screening should be included in care plans.
• Nutrition advice and nutrition support teams should be routinely available.
• Strategies to detect, prevent, and treat malnutrition should be in place in all care settings, including the community, where most malnutrition originates.

Top tips for health in Local Authorities commissioned by ChaMPs (Cheshire and Merseyside Public Health Network) and from the Liverpool Public Health Observatory offers practical tips on joint working between the NHS and Local Authorities in the areas of:

• Reducing health inequalities

• Tackling obesity: Creating opportunities for healthy eating

• Tackling obesity: Creating opportunities for physical activity

• Improving mental health and well-being

• Promoting sexual health

• Encourage the sensible drinking of alcohol

• Creating a smokefree environment

Consumer Attitudes Survey 2007: UK report from the Food Standards Agency points to increased confidence among the public in the food they are consuming, and with regard to wider food issues.

Diet and Nutrition

78% of consumers are now aware that we should be eating at least five portions of a variety of fruit and vegetables each day and 58%, also an improvement on last year, claimed to be putting this into practice by eating at least ‘5-a-day’

The amount of fat, saturated fat, salt and sugar in foods are still the top issues of concern among consumers and the quantity of fat and salt are the most commonly checked for nutritional information on labels. However, the percentage of people who are concerned about these is slightly down since 2006.

Nine out of ten respondents claimed that healthy eating is important to them, and 87% also believed that a limited budget is not a barrier to healthy eating, with those aged over 50 more likely to agree with this sentiment than those in any younger age group.

Food Hygiene

There is a decrease since 2006 in concern over many food safety issues including additives (35% down from 38%), food poisoning (36% down from 42%), GM foods (20% down from 25%).

Food labels remain important to shoppers looking for a range of information such as ‘best before’ dates, allergy advice and additives in foods. Half of respondents said they check some form of labelling information when buying food

Almost half of respondents in the survey did not know the difference between ‘use by’ and ‘sell by’ dates on food

Infant Feeding Survey 2005: A commentary on infant feeding practices in the UK provides national estimates of breastfeeding incidence and prevalence as well as capturing data on other aspects of infant feeding, such as the use of breastmilk substitutes and information about weaning practices. In addition, the survey collects information about the type and quality of antenatal and postnatal support available for pregnant and breastfeeding mothers. The survey thus identifies potential strengths and weaknesses that exist in the implementation of current infant feeding policy, uncovering for attention those areas in which mothers lack support

The survey recommends

• Promotion of breastfeeding needs to be tailored according to the social group. Attempts should continue to be made to increase the awareness of breastfeeding among young and low-income mothers by discussing infant feeding during pregnancy and providing support in tackling practical barriers to breastfeeding.

• Raising awareness of the health risks associated with not breastfeeding is crucial
  if mothers are to make informed infant feeding decisions. An emphasis on the
  benefits of exclusively breastfeeding for the first six months, in conjunction with
  advice to delay introduction of solids until around six months is required.

• Further practical support which helps mothers to wait until six months, and an appropriate change in the labelling of weaning foods would be beneficial.

• Inequalities in access to antenatal and postnatal care are apparent. Identifying sub-groups of women who do not use maternal health services is key to improving policy adherence. There is a need to make antenatal and postnatal services more accessible for women from hard-to-reach groups and encourage them to use these services more frequently.

• Hospitals should facilitate practices conducive to breastfeeding, such as initiating breastfeeding soon after birth and encouraging close contact between mother and baby. All hospitals should have a written breastfeeding policy that is communicated and implemented.

• All women and their families should also be given information about availability
  and access of postnatal care in their local community, and health professionals working in the community need to ensure that infant feeding advice and support is widely available for mothers who require it.

• The Baby Friendly Initiative (BFI) sets rigorous standards for health care organisations to adopt, with the aim of improving breastfeeding rates. Further encouragement should be given to all health care providers, both hospital and community, to implement a structured programme such as the BFI. All health professionals should be made aware of the NICE guidance on postnatal care.

• There is a need to encourage training of health professionals in practical management of breastfeeding support and to maintain relevant skills.

• Provision of infant feeding facilities in both work and public places should be encouraged in order to welcome breastfeeding mothers and establish breastfeeding as the norm.

• Parallel to the promotion and support of breastfeeding practices, there is a need to provide clear, independent professional advice on infant formula and follow-on formula, particularly among hard-to-reach groups of mothers.

• It is vital that all parents and carers who choose to give their babies infant formula are offered appropriate and tailored advice on formula feeding, to ensure this is undertaken as safely as possible.

• All health professionals working with children, pregnant women and mothers, should as part of their training, be informed of the importance of vitamin supplementation during pregnancy and breastfeeding, particularly with regard to vitamin D and folic acid.

• Forthcoming NICE guidance for primary care on Maternal and Child Nutrition in low-income families, implementation of which will help to promote improved infant feeding practices.

The new issue of Journal of Epidemiology and Community Health is now available online. If you want to access the full text of the journal you’ll need your Athens password from the NHS (at the moment you’ll need one from Cheshire and Merseyside but from April this resource will be available nationally. If you don’t have an Athens password and are eligible you can get one here). Full contents of the Journal of Epidemiology and Community Health 2008 62(2) February

In this issue
Carlos Alvarez-Dardet and John R Ashton, Joint Edit
J Epidemiol Community Health 2008; 62: 89. [Extract] [Full text] [PDF]

“If you always do…”
JRA
J Epidemiol Community Health 2008; 62: 90. [Extract] [Full text] [PDF]

The subtle trade-off between personal freedom and social responsibility
Francesco Zambon
J Epidemiol Community Health 2008; 62: 90. doi:10.1136/jech.2007.065847 [Extract] [Full text] [PDF]

Area deprivation and mortality in the provincial capital cities of Andalusia and Catalonia (Spain)
R Ocaña-Riola, C Saurina, A Fernández-Ajuria, A Lertxundi, C Sánchez-Cantalejo, M Saez, M Ruiz-Ramos, M A Barceló, J C March, J M Martínez, A Daponte, and J Benach
J Epidemiol Community Health 2008; 62: 147-152. doi:10.1136/jech.2006.053280 [Abstract] [Full text] [PDF]

Adult education and child nutrition: the role of family and community
H Moestue and S Huttly
J Epidemiol Community Health 2008; 62: 153-159. doi:10.1136/jech.2006.058578 [Abstract] [Full text] [PDF]

Is leg length a biomarker of childhood conditions in older Chinese women? The Guangzhou Biobank Cohort Study
C M Schooling, C Q Jiang, M Heys, W S Zhang, X Q Lao, P Adab, B J Cowling, G N Thomas, K K Cheng, T H Lam, and G M Leung
J Epidemiol Community Health 2008; 62: 160-166. doi:10.1136/jech.2006.058917 [Abstract] [Full text] [PDF]

Fetal and childhood growth and the risk of violent and non-violent suicide attempts: a cohort study of 318 953 men
E Mittendorfer-Rutz, D Wasserman, and F Rasmussen
J Epidemiol Community Health 2008; 62: 168-173. doi:10.1136/jech.2006.057133 [Abstract] [Full text] [PDF]

The epidemiology of fractures in England
L J Donaldson, I P Reckless, S Scholes, J S Mindell, and N J Shelton
J Epidemiol Community Health 2008; 62: 174-180. doi:10.1136/jech.2006.056622 [Abstract] [Full text] [PDF]

Explaining the social gradient in long-term sickness absence: a prospective study of Danish employees
Karl Bang Christensen, Merete Labriola, Thomas Lund, and Mika Kivimäki
J Epidemiol Community Health 2008; 62: 181-183. doi:10.1136/jech.2006.056135 [Abstract] [Full text] [PDF]

Living and health conditions of Palestinian refugees in an unofficial camp in the Lebanon: a cross-sectional survey
J E Zabaneh, G C M Watt, and C A O’Donnell
J Epidemiol Community Health 2008; 62: 91-97. doi:10.1136/jech.2006.054338 [Abstract] [Full text] [PDF]

Reducing ambient levels of fine particulates could substantially improve health: a mortality impact assessment for 26 European cities
Ferran Ballester, Sylvia Medina, Elena Boldo, Pat Goodman, Manfred Neuberger, Carmen Iñiguez, Nino Künzli, and on behalf of the Apheis network
J Epidemiol Community Health 2008; 62: 98-105. doi:10.1136/jech.2007.059857 [Abstract] [Full text] [PDF]

Perceived health change in the aftermath of a petrochemical accident: an examination of pre-accident, within-accident, and post-accident variables
M K Peek, M P Cutchin, D H Freeman, N A Perez, and J S Goodwin
J Epidemiol Community Health 2008; 62: 106-112. doi:10.1136/jech.2006.049858 [Abstract] [Full text] [PDF]

The association between school attendance, HIV infection and sexual behaviour among young people in rural South Africa
J R Hargreaves, L A Morison, J C Kim, C P Bonell, J D H Porter, C Watts, J Busza, G Phetla, and P M Pronyk
J Epidemiol Community Health 2008; 62: 113-119. doi:10.1136/jech.2006.053827 [Abstract] [Full text] [PDF]

Iron but not folic acid supplementation reduces the risk of low birthweight in pregnant women without anaemia: a case–control study
S Palma, R Perez-Iglesias, D Prieto, R Pardo, J Llorca, and M Delgado-Rodriguez
J Epidemiol Community Health 2008; 62: 120-124. doi:10.1136/jech.2006.052985 [Abstract] [Full text] [PDF]

Prevalence of overweight and obesity in East and West German children in the decade after reunification: population-based series of cross-sectional studies
C J Apfelbacher, J Cairns, T Bruckner, M Möhrenschlager, H Behrendt, J Ring, and U Krämer
J Epidemiol Community Health 2008; 62: 125-130. doi:10.1136/jech.2007.062117 [Abstract] [Full text] [PDF]

Preventing disability through understanding international megatrends in Deaf bilingual education
I M Munoz-Baell, C Alvarez-Dardet, M T Ruiz, R Ortiz, M L Esteban, and E Ferreiro
J Epidemiol Community Health 2008; 62: 131-137. doi:10.1136/jech.2006.059378 [Abstract] [Full text] [PDF]

Medical illness, medication use and suicide in seniors: a population-based case–control study
D C Voaklander, B H Rowe, D M Dryden, J Pahal, P Saar, and K D Kelly
J Epidemiol Community Health 2008; 62: 138-146. doi:10.1136/jech.2006.055533 [Abstract] [Full text] [PDF]

Coronary heart disease epidemiology: from aetiology to public health, 2nd ednChildhood cancer in Britain
Alberto Izzotti
J Epidemiol Community Health 2008; 62: 184. doi:10.1136/jech.2006.045831 [Extract] [Full text] [PDF]

Childhood cancer in Britain
Kathrine Carlsen
J Epidemiol Community Health 2008; 62: 184. doi:10.1136/jech.2007.064709 [Extract] [Full text] [PDF]

If you need any training in using this or any other electronic resource and you work for Liverpool PCT use the contact form below to contact the library.

The Links Between Diet and Behaviour: The Influence of Nutrition on Mental Health from Associate Parliamentary Food and Health Forum (FHF), an all-party independent forum for the exchange of views and information on food policy in the UK Parliament.

The report makes the following 19 recommendations:

• The Government – principally the Department of Health, the Department for Children, Schools and Families and the Ministry of Justice, working with the FSA and the Medical Research Council – commission and support further research in the areas highlighted in this report.

• The Scientific Advisory Committee on Nutrition (SACN) should be asked to define further the optimum intake of omega-3 polyunsaturated fatty acids (PUFAs) in different stages of life, especially for pregnant women and children.

• The FSA should reconsider its advice to pregnant women about fish consumption, with a view to encouraging them to eat two portions of oily fish, or the equivalent in omega-3 PUFAs, a week.

• The FSA continues to monitor closely levels of mercury, dioxin and dioxin-like polychlorinated biphenyl (PCB) in the different species of oily fish available in the UK.

• The Royal Medical Colleges and the GMC consider upgrading the role of nutrition in the medical curriculum.

• Primary Care Trusts (PCTs) should increase the number of posts for dietitians working in the community and that GP practices should be fully reimbursed if  they employ a dietitian to whom patients can be referred for nutritional advice.

• The Government should take further action to raise public awareness of the significance of good nutrition in pregnancy and to tackle the incidence of low birth-weight in the UK.

• More research to test the effect of selected essential fatty acids on the cognitive skills, mood and behaviour of both “healthy” children (that is, children suffering from no known disorders), as well as children suffering from a range of behavioural disorders should be undertaken.

• Regulations should be introduced to prohibit all artificial colours and on-essential preservatives in food products and soft drinks.

• The Government should include financial support to School Breakfast Clubs as part of the package set up to improve school meals. We strongly recommend that all children entitled to free school lunches should be entitled also to a free school breakfast whose content, like school lunches, should be subject to quantified nutritional standards.

• The Department of Health encourages NHS Trusts to adopt an approach similar to that pursued by the Doncaster and South Humber Healthcare NHS Trust which undertakes a nutritional assessment of patients suffering from depression and patients with early symptoms of psychosis and provides dietary advice to them.

• Consideration of the outcome of the next trial of nutritional supplements in Young Offender Institutes should be a priority for the National Offender Management Service (NOMS) given that our prisons are overcrowded and there is continuing concern about the mental health of prisoners, particularly young offenders at risk of self-harm and suicide.

• Aany dietary intervention that can be used to improve the behaviour and mental well-being of offenders held in custody should be given serious consideration by the NOMS.

• NOMS should look positively at the case for introducing nutrient-based standards for meals in prisons, similar to those introduced for schools, but based on recommended daily intakes for adults.

• Effective measures should be taken in all prisons to inform prisoners about the benefits of a good diet and to enable them to make healthy choices both while they are in custody and after their release.

• In all women’s prisons national nutritional standards should be introduced to ensure that the basic dietary needs of pregnant women prisoners are achieved.

• More research is urgently needed in the area of nutrition and behaviour because of the major potential benefit for the fields of education, crime, health and the well-being of vulnerable sections of society and we recommend that the Government devotes more resources to this, especially in corrective institutions and care homes.

• Department of Health messages on a healthy diet should emphasise the importance of a balanced diet for optimum mental as well as physical health.

• While research continues to identify and produce alternative sources of omega-3 PUFAs, the report recommends that all people in the UK should be encouraged to eat more fish, some of which should be oily fish, or its equivalent in omega-3 PUFAs.

Food: an Analysis of the Issues, a report from the Cabinet Office suggests that up to 70,000 lives could be saved every year if people improved their diets.  One in ten premature deaths would be prevented if Britons reduce the amount of salt, sugar and fat they eat, it was claimed. And people are digging an early grave for themselves by not eating enough fruit, vegetables, fibre or oily fish, according to a report by the Cabinet Office.  The risk from cancer and heart disease from poor diet is unrelated to the current rise in obesity.

Just into the library this special issue of Sociology of Health and Illness focus’ on Diversity, Inequalities and Ethnicity. You’ll need your NHS Athens password to access the full text articles. If you haven’t got one and you work for Liverpool PCT you can apply for one here.

Locating ethnicity and health: exploring concepts and contexts

Waqar I. U. Ahmad and Hannah Bradby

pages 795–810

• Abstract
• References

The Black diaspora and health inequalities in the US and England: does where you go and how you get there make a difference?

James Nazroo, James Jackson, Saffron Karlsen and Myriam Torres

pages 811–830

• Abstract
• References

Race and nutrition: an investigation of Black-White differences in health-related nutritional behaviours

Peter Riley Bahr

pages 831–856

• Abstract
• References

Describing depression: ethnicity and the use of somatic imagery in accounts of mental distress

Sara Mallinson and Jennie Popay

pages 857–871

• Abstract
• References

Hospice or home? Expectations of end-of-life care among white and Chinese older people in the UK

Jane Seymour, Sheila Payne, Alice Chapman and Margaret Holloway

pages 872–890

• Abstract
• References

Contextualising accounts of illness: notions of responsibility and blame in white and South Asian respondents’ accounts of diabetes causation

Julia Lawton, Naureen Ahmad, Elizabeth Peel and Nina Hallowell

pages 891–906

• Abstract
• References

Long-term health conditions and Disability Living Allowance: exploring ethnic differences and similarities in access

Sarah Salway, Lucinda Platt, Kaveri Harriss and Punita Chowbey

pages 907–930

• Abstract
• References

Interpreted consultations as ‘business as usual’? An analysis of organisational routines in general practices

Trisha Greenhalgh, Christopher Voisey and Nadia Robb

pages 931–954

• Abstract
• References

Retraction

Clive Seale

pages 955–955

• Summary

‘Racism, ethnicity, identity, and health: UK and US comparative perspectives’

Nancy Krieger

pages 956–956

• Summary

If you need some training to make the most of this or any other electronic resource available via the Fade Library and you work in Liverpool PCT, please contact us using the form below.

A third of cancers are caused by diet and lack of exercise and could be prevented, according to Food, Nutrition, Physical Activity and the Prevention of Cancer: a Global Perspective, which urges people to stay slim and abstain from too much fast food, red meat and preserved meat such as ham and bacon, and alcohol. The report from the World Cancer Research Fund, is the most authoritative overview of the role that food, drink, obesity and exercise play in causing cancer. Lifestyle could play almost as big a role as stopping smoking in preserving us from disease and that being fat is a big risk for cancer.

The mass media have been busy reporting on the report, 1st November, 2nd November, 4th November.