Can a stressful job be harmful to our health?

A certain amount of stress/pressure can “supposedly” be beneficial to us, by making us more productive. However, too much stress over a long period of time can have negative impacts on our health. A recent study from Spain sought to examine what these negative effects were and to what extent could stress increase the risk of developing cardiovascular diseases and coronary heart problems. 

The research was carried out by the insurance company Ibermutuamur, and two universities in Spain and the findings were published in the peer reviewed Scandinavian Journal of Public Health.

The purpose of the study was to determine whether a correlation exists between stress (from work) and abnormal levels of fat (lipids) in the blood. Worryingly, high levels of bad cholesterol known as LDL cholesterol – caused by fat in the blood - can block arteries which in turn may lead to coronary heart disease and other cardiovascular diseases.

Just over 90,000 people took part in the study which was conducted through questionnaires. Participants were asked questions relating to how they felt they coped in their job: “During the last year, have you frequently felt that you cannot cope with your usual job?". Participants who answered "yes" were considered to have job stress.

The questionnaire also included eleven questions relating to anxiety and depression symptoms, such as "Have you felt keyed up, on edge?" and "Have you had difficulty relaxing?” The researchers took fasting blood samples from participants measuring levels of total cholesterol, and then examined whether abnormal lipid levels were linked to job stress. The study did take into account age, sex, smoking, obesity, alcohol consumption and also type of job (blue or white collar occupation).

Results

Around 8,000 (9%) of participants are reported to have job stress; in addition these individuals also reported higher levels of anxiety and depression symptoms, and were found to have a 10% increase in abnormal lipid levels and higher levels of LDL cholesterol, than those who did not consider their job stressful.

Although these findings have been regarded as generally strong in understanding the relationship between stress and bad cholesterol, what the study did not take into account is that, individuals who suffer from stress or poor mental health, may indulge in high risk behaviour as a coping mechanism. This could increase their risk of developing higher levels of “bad” cholesterol as they may be more accustomed to unhealthier diets and/or consume higher levels of alcohol. Therefore, rather than the stress itself, these other “risky behaviours” may play a fundamental role in causing peoples “bad” cholesterol to rise.

Nonetheless, what this research highlights is that stress (too much of it) and poor mental health is detrimental for our wellbeing and for society as a whole. Whether it causes our cholesterol to rise or whether it causes us to indulge in health risk behaviour – the message remains clear that improving ones mental health should be paramount in order to tackle many of the other health related problems that exist in today’s society.

What can you do?

The RSPH believe that we all have a responsibility to ourselves and to others, to help prevent, protect and promote good mental health practices. As such a one day programme on Mental Health and Wellbeing has been developed, to provide people with practical skills and knowledge to understand the measures they can take to improve not only their own mental health, but also help the wider community. Click here to download the report on Mental Health in the New Public Health System and click here to find out more about our programme.   

The Seven Golden Rules for a Healthy Life

If we follow these simple steps, can we really reduce our risk of heart disease?

Cardiovascular disease (CVD) still remains the biggest killer in the UK.  In 2010, around 180,000 people died from CVD and 80,000 of these deaths were from coronary heart disease (CHD).  Although over the past decade, there has been a decline in death rates from heart disease in England, there still remains regional and socioeconomic differences in both incidence and case fatality, along with behaviour inequalities.

In 2010, the American Heart Association (AHA) proposed seven factors to help people understand the most effective ways of avoiding CVD and lowering the risk of developing cancer. 

The findings came from a long term study carried out by researchers from Northwestern University (Chicago), the University of Minnesota, and a number of other US research institutions; their findings were published in the peer-reviewed journal Circulation.  The cohort study followed 13,253 white and African American participants for between 17 and 19 years, to establish if maintaining ideal levels of the seven health factors could reduce heart disease and lower the risk of cancer. 

The Seven Simple Steps

• 1      Not smoking (never smoking or quitting more than 12 months ago
• 2      Maintaining a healthy body weight (that is a healthy Body Max Index (BMI)
• 3      Eating Healthily (diets rich in nutrition, fruits and vegetables)
• 4      Physical Activity (at least 75 minutes per week of vigorous physical activity, or 150 minutes per week of moderate or moderate plus vigorous activity
• 5      Having low cholesterol levels
• 6      Healthy blood sugar rates
• 7      Healthy blood pressure

The Findings

From the study, researchers found that the health benefits were higher among people who met the ideal levels for each of the seven factors.  For example, people who achieved ideal levels for six of more factors had a 51% reduced cancer risk and those who met the ideal levels of four factors had a 33% reduced rate of developing cancer.

While the findings have been welcomed, it is worth noting that smoking appeared responsible for the majority of the associations seen between the seven factors and cancer risk. This once again exemplifies how smoking has a direct correlation with your heart, blood pressure, circulation and individual risk of lung cancer.

What more can be done?

As highlighted above, CVD and CHD continues to be a major health concern in the UK, with health issues being more prevalent among low income earners. Those from lower socioeconomic groups are more likely to have poorer diets, lead sedentary lifestyles, suffer from mental health issues and partake in health risk behaviour, including smoking and alcohol abuse. These factors have a major impact on heart disease.

Type 2 diabetes and obesity are also some of the main contributors leading to CVD.  In England alone, a quarter of adults are obese and the prevalence of diabetes in the UK is around 5% for women and 6% for men.  The financial cost to society can also be detrimental.  The statistics reveal that in 2009, CVD cost the UK economy £19 billion – putting further strain on the health care system.

Although the AHA’s seven steps to improving health helps people to understand where to make the changes in their life (healthy eating, exercising), the problem is how to make these changes?  For most people, breaking old habits and changing behaviour can seem like an impossible task, and for some, change is not always welcomed. How do we engage with people and offer advice on sensitive issues that could potentially save their lives?

The RSPH, having recognised the fundamental importance of behaviour change to improve health, has developed a qualification in Understanding Behaviour Change, Level 2 Award, to provide an understanding of communication styles and practical skills to help individuals implement lifestyle changes. The one day programme will also aim to give learners knowledge and confidence to offer brief advice and engage in brief interventions.  Sometimes, having the right conversation with someone can have far reaching positive affects.   For further information on the qualification please click here or contact Gina Mohajer.

For further information on heart disease visit the British Heart Foundation here

International Women’s Day 2013

– Celebrating achievement and looking at what more can be done

Every year International Women’s Day is celebrated on the 8^th March. This monumental day seeks to highlight the extent to which equal rights of women have progressed, as well as emphasising the economic, political and social achievements women have and continue to make.

Each year there is a thought provoking theme, to not only celebrate achievements, but to also raise awareness of the issues and discrimination women still experience in the 21st Century. This year the United Nations (UN) core campaign is to end violence against women “A promise is a promise: Time for action to end violence against women”.

Ban Ki-moon, United Nations Secretary said “Violence against women is always a violation of human rights; it is a crime; and it is always unacceptable.  Let us take this issue with the deadly seriousness that it deserves”.

Violence against women continues to be a huge problem in society and can have serious adverse physical and mental affects on the individual and their families.  In the UK, the cost to society totals around £20.1 Billion, which includes human and emotional cost, cost to public services and cost in lost economic output. 

How widespread is the abuse?

The British Crime Survey 2006/2007 established that every year 1.5 million women experience at least one incident of domestic violence abuse, which is nearly 30,000 women a week. Over a lifetime, it is argued that one in four women in the UK will experience domestic violence.

Anyone can be targets of violent domestic abuse, married or unmarried couples, opposite or same sex partners, however, figures show that approximately 77% of the victims are predominantly women. This could be due to a whole range of factors, including cultural differences (i.e. men considering themselves too superior or 50% of men believing that domestic violence is a private affair), life experiences, psychological and emotional issues.

The Home Office Statistical Bulletin: Crime in England and Wales 2006/2007 highlighted that 2000 women are raped a week, resulting in 100,000 every year, and half of these rapes are committed by a current or former partner.

Lesley Abdela, Journalist at the Guardian “Stop looking the other way” wrote that, “Violence against women is a pandemic more extensive than HIV/Aids. It is the main cause of death and disability globally for women aged 15 to 44 – rape and gross bodily violence cause more death and permanent disability than cancer, motor vehicle accidents, war and malaria combined”.

Worryingly, Lesley comments that between one and two women are killed each week by a current or ex partner, and that this number is actually 20% higher than the number of youngsters knifed to death in London or in British cities. 

The affects

Domestic violence against women can have serious implications. As well as the damaging physical health problems that can arise from abuse, there are also notable adverse affects to an individual’s mental and emotional wellbeing; these include post-traumatic stress disorders, depression and anxiety. Moreover, many women turn to taking drugs, alcohol, smoking or overeating as a response to and a way of dealing with the abuse. Statistics reveal that abused women are 15 times more likely to misuse alcohol and 9 times more likely to take drugs than women generally. This can lead to greater physical and emotional problems.

As mentioned above, there is a large economic cost to society as women who are abused often take time off work. Statistics from the Home Office Statistical Bulletin, states that each year one in ten victims of partner abuse takes time off work as a result of the abuse.

Then and now

Until 1990, it was legal for a man to rape his wife.  The idea that domestic violence is a “private family affair” is still widely believed and is one that needs immediate eroding.  Domestic violence is a crime, and if ignored can lead to greater problems for the victim, their families and society as a whole.

International Women’s Day, is a fantastic opportunity for everyone around the world to acknowledge the great achievements of women and the contributions they have made socially, politically and economically, but it also an opportunity to make evident the problems women continue to face world wide.  Through the media, policy makers and the government, we can help to reduce and end domestic abuse and to also ensure a strong support network system is in place to offer advice and guidance to those who have suffered.

For more information on International Womens Day click here

For further information on violence against women click here 

Visit the Women's Health website here 

  

Can mobile apps help people lose 

weight...and keep it off?

Many of us may be well accustomed to using health and fitness mobile apps that have the sole purpose of counting calories and measuring activity levels, to help us lose weight. With the majority of people now using Androids and iPhones, downloading apps to our mobile phones is easy and hugely popular. As a result, tracking what we consume on a daily basis has never been so simple. 

However, how effective are these calorie counting apps? Can technology really aid us in reaching our ideal weight, or is it just a fad, a fashion accessory that will be forgotten with the next diet fix?  Furthermore, as with all successful weight loss, does it come down to our own behaviour and self motivation to bring about healthy changes to our life?

A recent study from the Northwestern University Feinberg School of Medicine, identified as the first of its kind, sought to examine the relationship between technology and the impact it had on weight. The study will be published in the Archives of Internal Medicine. 

The Study and Findings

The Northwestern technology research incorporated behaviour change techniques, including self monitoring, goal setting, feedback and social support.

The research examined a cohort of sixty nine overweight and obese men who were an average age of fifty eight. All participants were offered health education classes on nutrition, exercise and behaviour change; every two weeks during the first six months and once monthly for the remainder of the year. 

Each participant received personalised weekly calorie and activity goals to help them lose weight and all participants were encouraged to attend nutrition and health classes. The participants were divided into two groups. One half recorded their activity and diet on paper, whilst the other half used the Northwestern technology mobile device, to transmit their data to a behaviour coach, who monitored and provided feedback twice a month. 

From the evidence, it was found that those who used the mobile device and attended eighty percent of the nutrition classes lost fifteen pounds and maintained this for one year. The weight loss for those who used the mobile app but who did not attend any classes lost almost nine pounds. The group who attended classes but did not use the mobile app, did not loose any weight. 

The lead investigator of the study and Professor at the University, Bonnie Spring, found the results to be positive and argued that mobile devises could have a significant role to play in making people more health aware; "The app is important because it helps people regulate their behaviour, which is really hard to do....Most of us have no idea how many calories we consume and how much physical activity we get. The app gives you feedback on this and helps you make smart decisions in the moment." 

However, Spring also emphasised that weight loss only occurred when people attended health education classes and engaged in regular exercise. The app alone would not be effective.

"The 'widget' is critical but it is not magical by itself," Spring added. "People need all the tools at their disposal." 

Should we all be downloading apps?

Diets usually fail because we end up eliminating certain food groups – and in the long term this is not sustainable. The difference between “diet fads” and calorie counting mobile apps, is that the latter can help set achievable and realistic goals, whilst simultaneously tracking our calorie intake and activity levels. 

It is often the case that we do not realise how many calories certain foods contain, and so, we are ignorant to all the hidden fats/sugars.  Thus, these quick and easy food tracking devices empower us to make sensible and more informed decisions that govern our health and weight. 

A frequent user of a calorie counting mobile app, Koorosh Ashrafi, PhD Research Scientist at BTG International group company, says; “I’ve lost 10 kilos over the past 6 months, and you learn balance is the key.  I’ve lived quite a sedentary lifestyle because of the pressure of work and studying, and I was still consuming the same amount of calories as 10 years ago when I was training as a rugby player.  Although I am a firm believer of everything in moderation, having a device at the tip of your fingertips, really does educate you about food and its content”

Nelly Araujo, Development Administrator at RSPH, and previous user of the mobile app says; “The goal setting was a motivational tool for me, but I found doing the mobile exercise with my partner, is what also drove me to make healthy changes – because we could support and encourage each other”

Bringing about behaviour changes in our life is no easy task.  We have to want to do it and it helps if we have the right tools at our disposal along with a good support network.

Spring believes that one of the big challenges in treating obesity is the need to provide behavioural treatment in a healthcare system where professionals don’t often have the time and training to support people with unhealthy diets or mental problems.

The RSPH is a strong advocator of the benefits of making healthier behavioural changes, but acknowledges that for many this can be challenging. The RSPH Level 2 Awards in Understanding Behaviour Change, is a qualification aimed at helping learners, health trainers and anyone working within the community to engage with individuals to develop strategies to undergo behaviour change and to offer brief advice and interventions to support individuals in improving their health and wellbeing.  Please click here for further information on the qualification, or contact Gina Mohajer.   

Understanding Behaviour Change: 

Happening at all levels

On the 29^th November 2012, the Royal Society for Public Health (RSPH) held a seminar on behaviour change. Led by Graham Rushbrook Development Advisor for RSPH, there was a chance to learn about the RSPH’s new Understanding Behaviour Change qualification, as well as to hear Kent Community NHS Health Trust’s experience of using the qualification. Participants then engaged in discussion about their experiences of obstacles to behaviour change for their clients.

The RSPH Understanding Behaviour Change qualification focuses on how best to support individuals in adopting positive behaviour change. At the heart of effective behaviour change is effective communication and relationship building. Within a one-to-one setting, the needs of the client are at the centre of all interactions, and the focus is on the holistic support of clients – not limiting support to narrow health requirements. As Graham highlighted, behaviour change “is done with, not to people”.

If individuals are to choose to change their lifestyles, any fear or ambivalence first needs to be addressed. It is also essential that an individual’s right not to change their behaviour is respected, and that the context and circumstances that may affect development of a plan to change lifestyle or health behaviour information is understood. The qualification also covers the importance of presenting information appropriately and accurately based on the needs of the individual, and teaches how to develop an effective lifestyle or behaviour change implementation plan and how to evaluate the impact of advice given.

Anne Ford, Head of Self Management and Prevention at Kent Community NHS Health Trust, spoke about her experience of using the RSPH’s behaviour change qualification to enable Health Trainers to support people with chronic health conditions. She highlighted that the effectiveness of behaviour change techniques lies in their client-centred nature and underlined the potentially valuable role of Health Trainers in supporting individuals in self management. The assessment of the Kent Community NHS Health Trust self-management and prevention plan has shown that through behaviour change training, Health Trainers have offered a wide range of support to clients, including referrals, signposting, accessing services from Age UK, organising respite care and supporting improvements in eating habits.

The RSPH qualification is set at Level 2, involves 16 hours guided learning time and is assessed through a multiple choice exam. Graham Rushbrook then led participants through a workshop session, asking participants to assess how the organisations, systems, disciplines and professions that they represent make it harder for clients to change.

Participants suggested that if behaviour change interventions are to be successful and sustainable:

-      There needs to be a holistic focus on the client, enabling underlying issues as well as health behaviours to be addressed. The client needs to be at the centre of the decision making process and interventions must be tailored to their needs.

-         Frontline staff need to buy into behaviour change techniques and training needs to be provided to enable them to work effectively with clear and consistent models. Communication between frontline services is vital if clients are to be treated holistically and effectively.

-    Behaviour change interventions need to be better understood by funders and management. This will involve recognition of the timescales involved (behaviour change interventions are not quick-fix) and also that quantifying results may not be possible in traditional ways.

Participants then looked at how these difficulties could be turned into opportunities for improving health. The focus in behaviour change theory on joined up services and holistic interventions, as well as developing partnerships was deemed an opportunity. In addition, moving the focus from assessing interventions based on quantity to assessment based on quality was seen as a huge opportunity for health improvement. It was also noted that behaviour change training can be achieved with little funding where training is offered in-house and that by sharing best practice between organisations and services, there is a great opportunity to ensure that behaviour change interventions meet their potential.

Next Steps

RSPH Training Solutions, will be running training sessions throughout 2013 to build understanding about behaviour change and to also build capacity to deliver the Behaviour Change qualification and training.  Our first date for this will be on the 26th February followed by a Train the Trainer programme on the 5th March.  For further information on opportunities to share best practice and offer in house training please contact Gina Mohajer, 0207 265 7327 or visit Training Solutions homepage. 

We will also be hosting further seminars around behaviour change to facilitate an engaged discussion with funders and commissioners about the case for supporting this type of intervention.  The next one will be in March, to register your interest, please contact Gina. 

Combating the myth that creativity 

is linked with mental illness!

The belief that creative people are more likely to suffer from mental illness, is an ancient notion that has transcended through the years and has long been part of our popular culture. The tortured artist or the visionary genius who succumbs to his/her own personal demons, is an image that is perhaps a little too familiar.   However, how legitimate is this concept ? Are creative people really prone to increased mental health issues? Or is being “creative” actually the coping mechanism to improve mental health?

Reverse the stigma

Previous studies, namely recognised as being poor and often subject to bias, have shown a link between creativity and mental illness. This could be a result of artists and writers who kill themselves often becoming high profile news items, and hence distorting the truth.  Artists and writers who live contented and well-balanced lifestyles are likely to attract less attention.

The study

Researchers from Gothenburg University and Uppsaala University in Sweden, sought to distinguish the association between creativity and mental disorder and whether in fact a correlation existed. The study used Swedish health records to identify more than a million people diagnosed with various mental illnesses. They compared the incidence of creative occupations among people with mental illness  against a matched sample of “healthy” people.

The study identified that people in creative professions were significantly less likely than people in other professions, to be diagnosed with schizophrenia, schizoaffective disorder, depression, anxiety disorders, alcohol abuse, drug abuse, ADHD or to have committed suicide.  The only exception to this was writers.  It was found that people who wrote for a living were twice as likely to suffer from schizophrenia and bipolar disorder and more likely to experience depression and anxiety disorder.

The study was however unable to identify how or why, people with certain creative talents or dispositions would be more likely to experience mental health problems.  For example, does being a writer lead to psychiatric problems? Or, do mental health suffers turn to creative pursuits in order to express themselves?

Arts/Culture as a way to improve mental health

Over the past few decades, research has emerged around the positive impact that arts/culture can have on health, particularly mental health. One such cohort study by a Norwegian researcher, Koenraad Cuypers, performed statistical analysis on the health data of 50,797 Norwegians, as part of the Nord-Trodelag Health Study. The evidence derived from the study showed that participation in cultural/creative activities were significantly associated with good health, good satisfaction with life, low anxiety and depression.  Further information on arts and health studies can be found at The Arts Research Monitor by clicking here http://www.artsresearchmonitor.com/articles.php?catUID=6 

  

In the UK, health professionals and creative artists have worked together for over 25 years using the arts to support healthcare and health promotion. Thus, the importance of arts as a way of improving health must not be underestimated. Whether you are watching a concert, visiting an art gallery, painting, singing, dancing or reading – these creative activities have been recognised as effective ways to decrease stress, create community cohesion and improve social interaction as well as providing a sense of relief from everyday life.

Dr. James Aw, Medical Director of the Medcan Clinic Toronto stated that; “Hobbies and interests outside of work are important for health. New experiences and expanding social networks through art and culture is one piece of the armamentarium in achieving optimal health and living well.”

Early 2013 the RSPH will be holding a new programme, "New Horizons," to address an emerging and widening interest in how the arts can positively impact health and wellbeing.  For further information or to register your interest please contact Gina Mohajer.

To conclude

From the Swedish study, although cause and effect was not ascertained, it nevertheless, highlighted the importance of good mental health and ensuring that those who suffer from mental disorders have the appropriate support and information available to them.    

The RSPH has been involved in promoting the benefits of mental health and demonstrating how this can be achieved. Good mental health is integral for all parts of life, not only for the individual but also for the affects it has on family, relationships, work and society as a whole. Thus, it is imperative for mental health to remain at the top of National and Local Government agenda and policy.

To read RSPH full report on Mental Health please click here.

Are you looking for creative ways to engage people in taking care of their minds?

Mindapples founder Andy Gibson will be presenting a half-day seminar at RSPH in London on November 15th, sharing lessons learnt about engaging people in the positive side of mental health.

The session will cover:

Tips and techniques for talking about positive mental health with the general public

The science of resilience and what psychology can teach us about looking after our minds

A selection of interesting facts about the workings of the mind that will engage and benefit your communities

A chance to share tips between participants about the most effective ways of engaging people in taking a more active role in maintaining their mental health

This session will particularly benefit health trainers, community workers and other professionals seeking to promote mental wellbeing and build resilience in patient groups and communities.

The cost of the workshop is £50 per person, if you are interested in attending please contact Gina Mohajer