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The Big Interview: Brighton and Hove director of public health, Dr Tom Scanlon
11:40am Sunday 25th November 2012 in News
The impact of alcohol on the city continues to be a major concern for Brighton and Hove director of public health, Dr Tom Scanlon. In an interview with The Argus, he also reveals his dislike of the “war on drugs” and the worrying rise in sexually transmitted diseases.
THE ARGUS (TA): How bad is the drinking problem in Brighton and Hove?
TOM SCANLON (TS): Alcohol is and has been for many years a problem in Brighton and Hove. We are in the worst third of the country for virtually all of the standard alcohol indicators: binge drinking, hospital admissions and crime.
Each week around 100 people are admitted to hospital as a result of alcohol – either as an acute event or more commonly the longer term impact, and an average of 66 people call an ambulance each week because of alcohol.
Our levels of drinking in young people are higher and just about all these indicators, apart from alcohol related crime, are getting worse rather than better.
(TA): Is it not okay to get drunk now and again? Do you not do that?
(TS): Personally, it’s not something I do, neither for relaxation nor for celebration.
I do enjoy alcohol, in most of its forms actually, but I don’t like the feeling of not being fully in control of myself and so I drink for the taste of it.
(TA): What, if any, drugs should be legalised and why?
(TS): This raises lots of tensions, but it’s almost becoming the wrong question. If you look at the deaths from ‘drugs’, most deaths are from tobacco and in second place it is alcohol.
Illegal drugs come a long way behind. In fact illegal drug deaths are falling.
We also have considerable concern about another group of legal drugs, the so-called “legal highs”.
We don’t know a lot about these drugs but a lot of younger people are choosing to use them, sometimes with disastrous effects.
So simple legalisation, while it might reduce a certain type of crime, it certainly won’t solve all our drug problems.
That said, I am against the concept of a ‘war on drugs’ which, to me, misses the point.
A lot of people use drugs, legally and illegally. Increasingly some of them view it as a lifestyle choice rather than consider it an addiction.
What we do need is to be able to have a sensible conversation about what we, as a society, are willing to tolerate as a lifestyle choice and then look at how we regulate it.
(TA): The city has experienced outbreaks of measles over the last few years, suggesting that not enough people are getting vaccinated. What would you say to new parents worried about giving their child the MMR vaccine? Why is this such a problem in Brighton and Hove?
(TS): We have seen another outbreak of measles across Sussex this year, with Brighton and Hove again, one of the worst areas affected.
These outbreaks are likely to continue as we now have a large group of children and young adults who weren’t vaccinated because of the MMR scare, a scare that has long since been shown to have no basis.
The MMR vaccine is the most tested vaccine we have, so we can say with a lot of certainty, this is a very safe vaccine. Measles isn’t a simple disease.
In years gone by we had a lot of child deaths from measles. In the last outbreak in the city a few years ago, we had just under 50 children admitted to hospital with serious complications.
There is a group of people in the city who don’t believe in vaccination and a bigger group that doesn’t believe in MMR.
These beliefs might be based on things they have read or heard, but they are not based on science. So it may be that trying to convince them with science is never going to work.
We in the public health community have to accept that some people just will never agree with vaccination, and even if – more likely when – their children catch measles, many of them will still try and justify their approach.
That shouldn’t stop us trying to get the message out and we will continue.
Measles is a very contagious disease, it has the potential to be very unpleasant, sometimes serious and occasionally fatal.
The MMR vaccine by contrast is safe and effective.
(TA): Has the smoking ban worked? Should we go further and ban tobacco?
(TS): The ban seems to have worked in terms of reducing the numbers of passive smokers and virtually all people now appreciate the fact that smoking is not allowed in public places.
It has also worked in terms of reducing the numbers of smokers, many of whom have become more fed up with the idea of having to go outdoors to smoke.
We are seeing the removal of tobacco displays and more and more we will see smoking becoming a fringe activity.
That is all good, as it remains the single biggest preventable cause of premature death.
I am pretty happy with the way things are going now. What I want to see is more of them come forward for help in stopping, we know that more than half of them want to stop, so we need to keep on trying to help them.
I don’t think we are ready for a complete ban on tobacco just now and I wouldn’t push for it. But who knows, in 50 years time we may be discussing how on earth we let this killer be sold so easily, and why people like me weren’t more aggressive in getting rid of it completely.
(TA): How are we going to tackle the growing obesity problem?
(TS): We are lucky in that local levels of obesity, including obesity in children, are lower than the national average, and – contrary to most trends around the country, levels of obesity in children in the city seem to have fallen each year for the last four years.
The datasets are not totally complete but that seems to be the trend.
If we want to tackle it effectively we do need some national action on food labelling, food pricing and food processing. I don’t think there is any escape from that.
There are things that we can do locally as well however. I would like to open much more of a dialogue with local supermarkets about how we can help them and they can help us tackle weight problems.
I think we should also do more to help work forces: supermarket workers, white and blue collar workers and workers in the public sector.
The NHS actually has high levels of obesity among its staff. We tried to kick-start something with the public sector last year but it never really took off and I would like to try that again.
We did a great piece of work with Brighton Sheet Metal Workers last year which saw the workforce lose weight, eat better, take more exercise, smoke less and yes, take less sick leave and improve productivity.
The staff and management all spoke very positively about the experience.
We have spoken to Sainsbury’s locally and they are keen to work with us. So I see us as making much more progress on this in the next few years.
We have a member of the public health team dedicated to working with employers and the workforce, but actually at times he struggles for business.
This is an area where there is scope for doing much more.
(TA): Despite the many campaigns and warnings, both locally and nationally, people are still choosing to smoke, drink too much and put themselves at risk by not practising safe sex. Do health promotion campaigns really work or does the finger-wagging just create a more entrenched position?
(TS): Campaigns only work for a brief period, whether they are about cancer and chronic disease detection, smoking cessation, drinking too much or whatever.
They do help raise the profile of pieces of work and we do use them.
Flu is a good example and last year, when the flu vaccine campaign was dropped nationally, we saw a fall in take up and more cases of flu, which in certain groups can be a fatal infection.
So they do work. Finger wagging is a different matter. It doesn’t work and campaigns don’t aim to do that.
To use the jargon, they aim to “empower”. It’s about giving people the information and leading them to a point where they want to change and have the support to change.
We need to be smart in how we do that.
(TA): Some people in poorer parts of Brighton and Hove are dying younger than those in other areas. Why is that, and what can be done about it?
(TS): A few years ago I looked at this by examining the information in the old medical officer annual reports for Brighton, which go back over 100 years.
Interestingly there was concern about this in the early reports and sure enough, when I looked at the health gap between rich and poor then and now, it hadn’t changed all that much.
So while infant mortality has fallen dramatically in rich and poor over the last 100 years in Brighton, the ratio of deaths has not changed that much at all.
So part of me thinks this issue will always be with us.
We all want to do what is best for our loved ones and those who have most resources will always tend to do better.
That isn’t to say we should just sit and watch it happen. What it means is that when we introduce a service, we need to target it.
We know for example that it takes about eight contacts to convince a smoker to stop in the east of the city compared to just one or two in the west.
So if we applied the same level of service across the city the gap would just get wider.
So we need to target our services so that we can reduce this gap and in the end, try to give everyone the same opportunity of good health.
(TA): What are your biggest health concerns for the future?
(TS): I think alcohol remains one of our biggest concerns.
I also see mental health as something that will become an ever-increasing concern, perhaps not serious mental illness but lower levels of emotional and mental wellbeing, which can be quite distressing to sufferers and those around them.
I do see this a fair bit in my general practice.
It is something we have highlighted as a priority for the city and an area where we could pull a lot of good work together better.
Another related thing which concerns me is what people call “resilience” - how we help individuals and communities to look after themselves and one another better.
This is an area that is more likely to be at the receiving end of cuts, it is hard sometimes to measure the effect of supporting a community group and that makes this kind of work more vulnerable to funding cuts.
Yet in the longer term, these sorts of things can make all the difference.
(TA): Why has the number of new HIV cases in heterosexual men overtaken that of homosexual men? Is this not a failure to get the message across to some sections of society?
(TS): The year on year increasing numbers of new HIV infections, whether in heterosexual or gay men need some considered thought.
While we don’t want to see more people infected, we know that there are a lot of people out there with the infection, who don’t know they have it, so we do want to identify them and offer early treatment which will help them, and reduce transmission of HIV in the community.
I had a very interesting meeting with the GUM consultants recently and we agreed that while there had been a lot of good work to get people seen and treated early, we were not so good at stopping the ever-rising tide of sexually transmitted infections.
So this is an area I would like to see us push more on.
Sexually transmitted diseases are avoidable diseases.
Even with the treatments available today they are not without potentially very serious consequences.
There is a clear relationship between risky sexual activity and alcohol excess.
This applies to both men and women.
So we are looking to try and link up better the people who work addressing alcohol problems and those who deal with sexually transmitted infections.
I think if we do that effectively, we could – for the first time in many, many years – see a drop in sexually transmitted infections.
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