Pioneering NHS adviser proposes a radical prescription for health care.

A leading government adviser has proposed a radical plan to persuade people to stop smoking, take more exercise and change their diets.

New figures published show that England tops the European league as the fattest nation in the EU. Professor Julian Le Grand, chair of Health England and a former senior Downing Street aide to Tony Blair, said a completely fresh approach was required by Government to reverse the epidemic of obesity and to tackle similar ills caused by "excess consumption".

In a speech to the Royal Statistical Society last night, Professor Le Grand said instead of requiring people to make healthy choices by giving up smoking, taking more exercise and eating less salt, policies should be framed so the healthy option is automatic and people have to choose deliberately to depart from it.

Among his suggestions are a proposal for a smoking permit, which smokers would have to produce when buying cigarettes, an "exercise hour" to be provided by all large companies for their employees and a ban on salt in processed food.

The idea, dubbed "libertarian paternalism", reverses the traditional government approach that requires individuals to opt in to healthy schemes. Instead, they would have to opt out to make the unhealthy choice, by buying a smoking permit, choosing not to participate in the exercise hour or adding salt at the table.

By preserving individual choice, the approach could be defended against charges of a "nanny state," he said. "Some people say this is paternalism squared. But at a fundamental level, you are not being made to do anything. It is not like banning something, it is not prohibition. It is a softer form of paternalism."

"Saying it is all the fault of society invites a nihilistic response, that nothing can work short of a revolution. We need new thinking and new ideas. We face new health challenges from obesity and old ones from smoking which add up to something of a crisis. There is a real risk that our children will die at a younger age than us," he said.

On smoking, he said permits could be issued annually and the signature of a doctor might even be needed. This would require individuals to "opt-in" each year to being a smoker, rather than "opting out" by choosing to give up.

"Sellers of tobacco from supermarkets to tobacconists would have to see the permit before any sale. To get a permit would involve filling out a form and supplying a photograph as well as paying the required fee. Permits would only be issued to those over 18 and evidence of age would have to be provided. The money raised for the permits would go to the NHS."

Professor Le Grand said the public health challenge was very different from half a century ago when William Beveridge founded the welfare state to tackle the "five giants" of want, disease, squalor, ignorance and idleness.

"His giants could be described as the giants of too little: too little income, too little work, too little education, too little housing, too little health care. Today's giants are the giants of too much."

Source: The Independent, 24 October 2007
Link: http://tinyurl.com/34japk

Finnish islands' sale of oral snuff has Brussels fuming

The European Commission has announced that it is taking Finland to court over the sale of oral snuff, called 'snus', on its Aland islands. 

EU Health Commissioner Markos Kyprianou said in a statement that the Commission has no tolerance for the sale of oral tobaco.

The EU's executive is hoping the European Court of Justice in Luxembourg will impose a fine and if Finland fail to pay the fine, there will be a daily penalty for not complying with an earlier ruling on the subject.

Snus is sold aboard the ferries plying the Aland islands, to islanders and Finnish and Swedish tourists.

The Finnish archipelago of 1,527 square kilometres, includes 6,500 isles and islets and a population of 25,000 Swedish speakers.

Since 1921 the islands have been autonomous in the matters of education, health and the police.

The Aland islands formally joined the European Union in 1995 with Finland, but the archipelago has reserved its "duty free" rights on the ferries to and from Sweden and Finland.

In May Swedish epidemiologists said that their investigations showed that oral snuff caused no risk of lung or mouth cancer but was linked to pancreatic cancer.

Source: EU Business, 23 October 2007
Link: http://tinyurl.com/2trslu

Age affects motivation for quitting smoking

A new study shows that obstacles to smoking cessation and motives for quitting smoking vary with age.

The study found that smokers over age 65 reported quitting smoking due to physician pressure and stress due to a major health problem, while smokers under age 65 reported cigarette cost and tobacco odor as reasons for quitting.

Virginia Reichert, lead author of the study said, "The current common perception among the medical community is that if smokers age 65 and older haven't quit by now, they can't or won't quit, a perception which may lead physicians to focus less on their older patients' smoking habit."

"Our results show that older smokers are motivated to quit smoking by very different factors compared with younger smokers. If these factors are addressed, we may see cessation rates improve for both age groups."

Ms. Reichert and colleagues from the Center for Tobacco Control at North Shore-LIJ compared health status and motives and obstacles for quitting smoking between 1,909 smokers under age 65 (younger smokers) and 143 smokers over age 65 (older smokers) who were attending a 6-week comprehensive cessation program.

The study found that older smokers were more likely than younger smokers to have a recent hospitalisation (23% vs 13%), comorbid cardiac disease (78% vs 38%), cancer (20% vs 7%), and/or chronic obstructive lung disease/asthma (37% vs 23%).

Obstacles to smoking cessation also varied by age group. Younger smokers were more likely than older smokers to report concerns of weight gain (30% vs 15%), stress management (59% vs 45%), fear of failure (15% vs 8%), handling social situations (24% vs 7%), and cravings (44% vs 36%) as obstacles to quitting smoking. 

"To be most effective, treatment plans and education should be relevant to each group's concerns," said Ms. Reichert. She suggests that health-care providers offer weight management programs and stress management strategies as part of the treatment and relapse prevention programs for younger smokers, while older smokers may be more successful with physician encouragement and knowledge of how smoking is influencing their current health conditions.

Source: Science Daily, 23 October 2007
Link: http://tinyurl.com/yobjzx

Teenage smokers may also be at greater risk for alcohol and drug abuse

According to a new report, smoking cigarettes may make adolescents more susceptible to depression, alcohol abuse, and illegal drug use.

Researchers concluded that young people who smoke are nine times more likely to abuse alcohol and 13 times more likely to abuse illegal drugs than teens who don't smoke.

The report, "Tobacco: The Smoking Gun" was released by the Columbia University's National Center on Addiction and Substance Abuse (CASA), led by former U.S. Health, Education and Welfare commissioner Joseph A. Califano Jr.

Califano says the report was issued to make parents, teachers, and physicians aware that the dangers of teenage smoking are immediate as well as long-term.

According to the CASA analysis, twice as many teenage smokers compared with non-smokers suffer symptoms of depression.

Smoking at a young age has also been linked to panic attacks and general anxiety disorders in some studies, the report notes.

The CASA analysis shows that teenage smokers between the ages of 12 and 17 are five times more likely to drink alcohol and nine times more likely to meet the medical criteria for alcohol abuse or dependence as teenagers who don't smoke. Adolescents who smoked were more than twice as likely to have suffered from symptoms of depression over the course of a year.

Califano says there is growing evidence from animal and brain imaging studies that the nicotine has a more profound effect on young brains than on the brains of adults, increasing their vulnerability to cigarettes and possibly other addictive substances.

Rather, the study showed that current cigarette use was a strong predictor of developing serious symptoms of depression within a year.

Elizabeth Goodman, MD, who led the study team, says the message that smoking has an immediate, detrimental effect on health is a very powerful one for young people to hear.

Source: WebMD, 23 October 2007
Link: http://tinyurl.com/2ub99c