Saving Lives Through Changing Behaviour

Fresh food, more exercise and no smoking.  These are some of the choices we need to make in order to lead a healthy lifestyle, which is sustainable in the long term.

The Royal Society for Public Health (RSPH) http://www.rsph.org.uk/ has responded to the Government’s White Paper, by developing a suite of training programmes on Behaviour Change designed specifically to support health and well being professionals to deliver these messages effectively as part of their behaviour change strategy. 

Professor Richard Parish, Chief Executive of RSPH comments:

“It is our belief that spreading skills and knowledge in this area will have a direct effect on driving behaviour change and reducing health inequalities, resulting in healthier communities across the country.”

Rises in obesity, diabetes, heart disease and sexually transmitted infections (STIs), alongside problems associated with unhealthy eating, drinking and smoking habits, have placed our health service under huge pressure.  As many health conditions are both preventable and avoidable, we have a responsibility to ensure that we intervene and steer people towards healthier lifestyle choices.  This not only positively impacts the wellbeing of the individual but also their communities.

Preventing avoidable conditions is better for both the patient and the health service, but the approach differs depending on the time available, the skill of the individual and the nature of the contact.

The programmes are tailored to help everyone and range from a short introduction for frontline staff right through to strategic planning for leaders and managers.

Influencing Behaviour Change

An introduction to communication and sign-posting

This one day workshop for front-line staff explores the potential improvements they could make to community health by influencing changes to behaviour. Drawing on motivational interviewing techniques and a variety of communication styles, participants will gain a clear understanding of how they can increase the impact of everyday contact with their community.

Making Every Contact Count

An introduction to the Behaviour Change competence framework

This half day programme introduces participants to the competence framework which has been developed by NHS Yorkshire and The Humber. It is designed for use at all levels of experience and provides a common approach against which skills can be assessed, either within a single programme or for an entire workforce. This will enable individuals to identify gaps in their knowledge, Commissioners to address weaknesses in their provision, and Service Providers to offer exactly what is needed.

To find out more about RSPH’s programmes on Behaviour Change please contact Gina Mohajer on gmohajer@rsph.org.uk 020 7265 7327or visit http://www.rsph.org.uk/en/training-solutions/index.cfm

Getting It Out In The Open - Lesbian, Gay and Bisexual People
Reducing Health Inequalities!

Sometimes as a society we tend to avoid issues that we do not feel comfortable with or perhaps do not understand and we may even falsely assume that everyone has the same health needs.  As a result, some people who are perceived as the most vulnerable and most in need of help, either get side stepped or fall through the net.  The Public Health White Paper Healthy Lives Healthy People, advocates a new approach to "reach across and reach out" to address the root causes of poor health to the people who need the most support.  With a particular emphasis on tackling health inequalities, high alcohol levels, smoking, mental health, sexual transmitted infections (STIs) and obesity.  We therefore have a responsibility to ensure people who experience health inequalities and are likely to be the most susceptible to the above, are not isolated or discriminated against, but are brought to the forefront of public health.

Lesbian, gay and bisexual (LGB) people tend to be vulnerable to a number of health risks because of people's reactions to their identity.  This can leave them feeling stigmatised and they are often unrecognised in health and social care settings.  Healthcare and other professionals have a misconception that LGB people's health needs are the same as those of heterosexual people, unless their health needs are related to sexual health.

A briefing written in 2007 by Dr Julie Fish as part of the Department of Health's Sexual Orientation and Gender Identity Advisory Group's work programme entitled "Reducing health inequalities for lesbian, gay, bisexual and trans people - briefings for health and social care staff" sought to highlight that LGB people can be younger, older, bisexual, lesbians, gay men, trans, from black and minority ethnic (BME) communities and disabled, and to dispel assumptions that they form a homogeneous group. 

Health Issues: What We Don’t know
Many young people know they are lesbian, gay or bisexual by the age of 11 or 12, but do not come out until they are 15 or 16 years of age.  The period between 11-16 years, has been described as the isolation years and has been identified as the time when young LGB’s need the most support and information.  During these critical “isolation years” LGB's may feel alone, confused and stigmatised particularly as it is also the period where they may encounter homophobic bullying in schools.  Evidence suggests that between 30% to 50% of young people in secondary schools, attracted to people of the same sex, would have experienced homophobic bullying, and that "gay" is the most frequent term of abuse in the playgrounds.  Young LGB people are also at risk of violence and victimisation and are likely to face verbal abuse, teasing, physical assault both in schools and on the streets. 

Feelings of isolation, fear of being unable to talk about their sexual orientation and the consequences of homophobic bullying can have an impact on a young person's mental health and which could have negative repercussions during their adult life.  The evidence taken from the briefing into young lesbian, gay and bisexual people, highlights that these young people are at increased risk of mental problems, are more likely to suffer from depression, to have attempted suicide (as a result of family denial, self loathing and leaving home) and lead unhealthier lifestyles than their heterosexual peers.  The statistics reveal that compared to their heterosexual peers, lesbian and bisexual girls are more likely to smoke and binge drink.  There is also an increased risk that young gay and bisexual men may take illicit drugs and may not be aware of  health risks from unprotected sex.  

The unhealthy lifestyles experienced by young LGB people can follow them into adult life.  Researchers have pointed out that LGB’s may use drugs, alcohol and tobacco as coping mechanisms in dealing with their homophobia.  However, they have also argued that the lack of social spaces for LGB’s means they are more likely to congregate in clubs and pubs and hence are more obliged to use the "scene" and fit in with a drinking culture. 

The Statistics:

Smoking: Young lesbian and bisexual women were almost 10 times more likely to smoke at least weekly compared with heterosexual women.
- 25% of lesbians are smokers compared with 15% of heterosexual women.
- 33% of gay men are smokers compared with 21% heterosexual men

Alcohol: Lesbian and bisexual women aged 20-30 years reported higher weekly alcohol consumption and less abstinence compared with heterosexual women

Drugs: In comparison with young heterosexual people, young LGB’s are:
- 3 times more likely to use MBMA/ecstasy
- 8 times more likely to use ketamine
- 26 times more likely to use crystal methamphetamine. 

Eating disorders:
- Gay men are more likely to engage in recurrent binge eating and purging which is often linked to aspirations to the ideal gay male body shape (slim and muscular).
- Lesbians are believed to have a higher body mass index than heterosexual women and may be more at risk of obesity. 

Good health should include everyone and that means reaching out to all segments of the population and understanding that different groups have different needs and requirements.  The rising levels of STIs and the fact that LGB people still feel discriminated against and continue to experience a number of health inequalities, signifies that more needs to be done to support them.  This may include how commissioners and providers deliver their services and how they are perceived by LGB service users.    

What Can You Do?
Training Solutions are offering a programme on Addressing Health Inequalities Experienced by Lesbian, Gay and Bisexual People on the 7th April.  The one-day course aims to raise awareness of the health and social care needs of lesbian, gay and bisexual (LGB) people, who are disproportionately affected by health and social inequalities. It will identify key research findings that affect LGB communities specifically, and examine how these relate to the statutory obligations for services. As the public health agenda broadens in the light of the forthcoming Equality Act, it is essential that health and social care services are accessible and meet the needs of all potential service users.

For further information please click here or contact Nicolette Smith 

Fall in Pregnancies for under 18's - Surely We Must Be Doing Something Right!?

Majority of health news reports this week have published a decline in the number of teenage pregnancy over the recent years.  Whether this information is to be applauded or looked at critically, (namely because the reduction is relatively small) remains to be discussed.  However, what the statistics do reveal is that this change is a step in the right direction and should therefore encourage Government and Policy Makers that more should be done.

Data from the Office for National Statistics (ONS) revealed a 5.9% decline in rates among under-18s between 2008 and 2009, to 38.3 per 1,000 teenagers aged 15 to 17. Overall, there were 38,259 pregnancies in this age group in 2009 compared with 41,361 in 2008, a decline of 7.5%.  Among under 16s, there were 7,158 in 2009, compared with 7,586 in 2008, a 5.6% drop. Some 60% of these pregnancies led to an abortion.

It has long been recognised that the UK has some of the highest levels of teen pregnancy and STIs in Western Europe, and it cannot simply be put down to a lack of sex education - because sex education has and continues to be taught in schools.  The problem stems from a whole array of complex issues, which may include low expectations of education and employment opportunities for young people (many teenage pregnancies are from predominately low socio-economic backgrounds) and an overall misconception and ignorance about sex from the adult world.  Other reasons may include a general break down in family values, less emphasis on marriage and greater acceptance of single parents in society. 

Nonetheless, the recent decline in conception rates amongst young people may be viewed as encouraging for policy makers and health workers who have worked hard at trying to bring down pregnancy rates in young people since they hit a high level in the early 1990's.  Simon Blake, National Director of the Brook Advisory Centres which are the biggest providers of sexual health services and advice to under 25s, says the fall in the figures reflect a lot of good work over the last 10 years.

However, the figures fell significantly short of the previous Government's target to reduce pregnancy in under-18s by 50% by the year of 2010.  A goal which the new Coalition Government has now abandoned.
Victoria Sheard, deputy head of policy at Terrence Higgins Trust, said: "So long as the number of teenage pregnancies remains high, there is a need for young people to be given more information to protect themselves. Young people tell us it's not always easy to get the information and support they need about sex from schools and we have to listen to them. That's why we strongly welcome plans to make sex and relationships education a statutory part of the national curriculum. But information alone is not enough. There's a range of contraception out there now, so it's essential that young people are easily able to access contraceptive services and choose the method that works best for them."

The message becomes clear, that there is more still to be done to continue to push down rates of conception for young people.  Here at the RSPH we are running a training programme on an Introduction to Sexual Health and Young People, with the primary aim to help people gain the confidence to support sexual health needs of young people.  Participants will also be taught techniques for incorporating discussion about sex and relationships into their everyday working practice.  The course is for anyone in the voluntary organisation, education or the health and social care sector, with particular responsibility for young people.
For further Information please contact Nicolette Smith or on 020 3177 1625 
We are interested to hear your thoughts about this subject.  We ask why do pregnancy rates still remain high in the UK and what more can we do to support young people to be better informed about avoiding pregnancy and STIs?

Lets Talk about Sex-ual Health!

In the recent White Paper "Healthy Lives, Healthy People" the Government highlighted the need for children’s health and well-being to be put high on the public health agenda.  It stated that teenagers and young people are among the biggest lifestyle risk-takers and as a consequence the White Paper flagged up that the rates of Sexually Transmitted Infections (STIs) such as Chlamydia have continued to rise since the 1990's with 15-24 year olds being the most affected group.

Facts for Thought:

The Health Protection Agency (HPA) compiled a report in 2008 called "Sexually Transmitted Infections and Young People in the United Kingdom".  It found that young people account for nearly half of all the STIs diagnosed in the UK despite representing only 12% of the population.  The statistics showed that they account for 65% of all Chlamydia, 50% of genital warts and 50% of gonorrhoea infections diagnosed in genitourinary medicine clinics across the UK in 2007.
The most common STI is genital Chlamydia with 79,557 diagnoses made in 2007 (1,102 per 100,000 population aged 16-24), a rise of 7% since 2006.  High rates were also reported for genital warts (682 per 100,000), a rise of 8% since 2006.  In addition in 2007, 702 young people were diagnosed with HIV, representing 11% of all new HIV diagnoses.

Although increases in STIs may reflect greater ascertainment of cases through rises in testing and improved diagnostic methods, it also indicates increased unsafe sexual behaviour among young people.

The NusringTime.Net published an article at the end of last year, explaining that the worrying rises in STIs is the result of a lack of knowledge and misconceptions about sexual infection and reproductive health.  The study "The Face Of Global Sex 2010: They won’t know unless we tell them" found a high level of ignorance about STIs across Europe.  
The Study was the Fifth in the Durex Network's research series and involved more than 15,000 people aged between 15 to 20 in 15 European countries.  As well as the UK, some of the countries included Belgium, France, Italy, Slovenia and Turkey.  Britons, it was found were worryingly relaxed about their sexual health, with almost eight out of ten young Britons (79.8%) believing they are at little or no risk of contracting STIs.

It is clear, that although efforts have been made to educate young people about the negative effects of having unsafe sex, the message is still not be absorbed and policy makers, schools, local governments still have a huge part to play in reaching out to all young adults.

The 2008 report published by the HPA produced some recommendations including making access easy for young people to sexual health services that can provide screening and treatment of STIs as well as delivering high quality personal, relationship and sexual health education.  

What We Can Do
The RSPH are offering a programme on an "Introduction to Sexual Health and Young People" which is being held on the 10th March in London.  The one day event is designed to give participants the confidence to support the sexual health needs of young people and techniques for incorporating discussion about sex and relationships into their everyday working practice.  The course is for anyone in the voluntary organisation, education or the health and social care sector, with particular responsibility for young people.
For further Information please contact Nicolette Smith or on 020 3177 1625