John Ashton

Open letter to Prime Minister David Cameron on food poverty in the UK.

There is a worrying gap in health circumstances and outcomes between rich and poor people in the UK. Complex though the reasons for this inequality are, the reality is that many hardworking families in the UK are living in poverty and do not have enough income for a decent diet. UK food prices have risen by 12% in real terms since 2007, returning the cost of food relative to other goods to that in the 1990s.

Public Health and the origins of the Mersey Model of Harm Reduction

In the mid-1980s in Liverpool, and the area surrounding it (Merseyside and Cheshire), harm reduction was adopted on a large scale for the first time in the UK. The harm reduction model was based on a population approach to achieve the public health goal of reducing the harm to health associated with drug use. The particular concern at that time was the risk of HIV infection, but there was also the issue of the health of a group of young people who were under-served by health services. To achieve the goal, services were developed that would attract the majority of those at risk within the community, not simply the few who wished to stop using drugs, and which would enable contact with the target group to be maintained so as to bring about the necessary changes in behaviour required to maintain health and reduce risk. This Commentary describes some of the background to the development of the Mersey Model of Harm Reduction from the memories and perspectives of two people who promoted harm reduction within the health service and the region.

Promoting the new public health in Mersey

WHEN Liverpool Town Council appointed William Henry Duncan as the first Medical Officer of Health in 1847, the appointment was not made out of any particular sense of vision. Rather, housing and environmental conditions were so bad that urgent action appeared to be necessary. Duncan had been the one physician locally with the necessary insight into the living conditions of his patients, and the necessary motivation to bring the situation to public attention1.2. The liberal reforms that were under way in response to the harsh effects of the industrial revolution meant that he was in the right place at the right time with pertinent things to say, and as a result he was listened to. As with Duncan, so with present-day health promoters, if only they are prepared to take their opportunities and involve themselves with what is now becoming well established — the new public health.

Health in Mersey — an exercise in community diagnosis

THE process of producing a community diagnosis for the Mersey Region is described. Such an exercise is recommended for its potency in agenda-setting, and establishing a frame of reference for health promo tion within the context of the strategy of Health For All By The Year 2000.

Evaluation of the international garden festival health fair

Mersey Regional Health Authoritys strategy for health promotion includes increasing the general publics awareness of the individual and collective action necessary to improve health. The development of a ‘Health Fair’ was part of this process. The Health Fair was established as a feature at the International Garden Festival in 1984 and was used to denote a range of activities rather than the building where some of the events took place. The objective was to provide active learning which involved people in a consideration of their health status in different ways. One particular aspect was fitness testing. A sample of 234 people who undertook the fitness test over a two week period were interviewed by questionnaire. Twenty-six percent of males and 25% of females were concerned about their results and of these, 70% intended to exercise more. A follow-up questionnaire, sent 12 months later, produced a 67% response rate. The most obvious behaviour change was that 27% had been exercising more and 37% said that their diet had improved.

The World Health Organization European Healthy Cities Network 30 years on

a Senior WHO Consultant to the WHO European Healthy Cities Network, Liverpool, England b Technical officer, Governance for Health Programme, Division of Policy and Governance for Health and Well-being, WHO Regional Office for Europe, Copenhagen, Denmark c Programme Manager, Governance for Health programme, Division of Policy and Governance for Health and Well-being, WHO Regional Office for Europe, Copenhagen, Denmark

Happy corporate holidays from Coca-Cola

Selling sugary drinks at Christmas

THE NEED FOR UPSTREAM THINKING

It has been said that medical workers are like life‐savers standing beside a fast‐flowing river. Every so often a drowning person is swept down, the lifesaver jumps in rescues and rescusitates them. Just as he or she has finished another drowning person appears and the imperative of saving people is such that there is never time to go upstream and see who is pushing everybody in. In public health terms the task of refocussing upstream is in part that of reorientating the education, training and perspective of health workers so that, for instance, the consultant in charge of a coronary care unit becomes interested in coronary prevention or the accident and emergency surgeon becomes active in road safety and the fight against drunken driving. However, the task is also about refocussing the population as a whole away from victim‐blaming towards a rounded understanding of what needs to be done.