HEADLINES

• Top GP condemns Britons for recklessly neglecting their health
• Opinion: Don't take offence if we lecture you on how to stay alive and healthy
• Smoking kills 8,000 a year in South-West
• Thai tobacco officials 'took B62m bribes'

• Top GP condemns Britons for recklessly neglecting their health

  Britain's top GP today launches a scathing attack on widespread reckless public behaviour towards food, alcohol and cigarettes, which he claims is causing growing levels of disease and early death.
  
  In a dramatic intervention in the public health debate, Professor Steve Field criticises parents, mothers-to-be, the very overweight, smokers and drinkers for damaging their own health, or their children's, through irresponsible actions.
  
  Writing in today's Observer, Field, chairman of the Royal College of General Practitioners, backs the controversial call by Andrew Lansley, the health secretary, for Britons to take more responsibility for protecting their health. "The truth is that too many of us neglect our health, and this is leading to increasing levels of illness and early death," Field writes. Soaring levels of diabetes, much of it caused by obesity, and the medical consequences of heavy drinking, which are affecting ever-younger people, illustrate this widespread failure, he adds.
  
  Discussion of the harmful medical consequences of ill-advised personal behaviour is curtailed because of its sensitivity, Field argues. "Too many people do not face up to the hard facts, as they perceive them to be an attack aimed, in particular, at the poorer members of society. But it is impossible to argue on medical or ethical grounds that such behaviour is acceptable."
  
  While arguing for health prevention to become an individual duty and start at home, Field makes it clear that he does not want people to be left to make lifestyle changes on their own or to see personal responsibility as a total solution. Those who seek to alter their behaviour need continuing NHS and government help, he adds. "So please don't take offence if we [GPs] tell you to lose weight or stop smoking or drinking. You need to face facts and take responsibility. Support is out there and it could save your life – and save the NHS a fortune."
  
  Anne Milton, the public health minister, said greater personal responsibility was vital. Many senior doctors also agreed, but stressed that government action was needed to help create a climate in which people could swap healthy for unhealthy behaviour, such as by monitoring big food companies. Lansley has alarmed senior doctors by saying the coalition will use much less regulation than Labour did to tackle problems such as obesity and smoking.
  
  GPs seek to help people live healthy lives "but every day we are confronted by the harm caused by smoking, excessive alcohol consumption and the 'tsunami' of obesity", adds Field, the leader of the country's 40,000 GPs.
  
  Irresponsible parents are damaging their children's health by smoking around them, feeding them unhealthy food and failing to act as good role models, he says. Mothers and fathers who smoke in cars carrying their offspring – who Field says "are committing a form of child abuse" – and at home in front of their children kill more young people than do accidental injuries.
  
  Agreeing with Field, Milton said: "We need a new public health movement, owned by everyone, for everyone's benefit. A movement that transforms the way in which the public's health is improved, but also revolutionises the way we think about it. As Field points out, personal responsibility is a key part of this."
  
  However, Milton added: "The government recognises that it cannot force people into behaving in a certain way. But we can help people make informed decisions and ensure that they are enabled and supported to make healthy choices."
  
  Professor Terence Stephenson, president of the Royal College of Paediatrics and Child Health, agreed some parents let down their children. "Of course paediatricians agree that people should take responsibility for their own lives. But young children cannot do that. What they eat and the environment they live in are determined by their parents. There is a role for society to protect young children from promotion of unhealthy foods and passive smoking. Would all parents strap young children into a car seat if it was left to choice rather than law?"
  
  Dr John Middleton, vice-president of the UK Faculty of Public Health, said: "A significant amount of ill-health is due to people's lack of personal responsibility. The NHS would have fewer burdens on it if people were more physically active, cut their alcohol consumption and ate a lower-fat, lower-sugar diet. The government and the NHS cannot do everything. But someone trying to give up smoking will find it easier if they get counselling and nicotine replacement therapy on the NHS, for instance."
  
  The government had a key role to play in promoting health, as shown by its crackdown on smoking and its fluoridisation of water supplies, said Professor Dinesh Bhugra, president of the Royal College of Psychiatrists. People who insisted on smoking despite all the warnings about it should retain their freedom to do so, he added.

  Source: The Observer, 08 August 2010
  Link: http://bit.ly/95W8Vz

• Opinion: Don't take offence if we lecture you on how to stay alive and healthy

  ASH Note: An extract from the article by Professor Steve Field chairman of the Royal College of General Practitioners who says we, not the state, must take responsibility for our wellbeing.

  In the space of three months, the thrust of public health policy has shifted towards a desire for individuals to take more personal responsibility for their health and the health of their children. It is a dramatic change in emphasis from the last government, sometimes accused of wanting to remove all our personal freedoms and make big decisions for us.
  
  Health secretary Andrew Lansley took a bit of a bashing when he referred to Jamie Oliver's school food initiative as "lecturing". But he's right when he says that more of us should be taking more responsibility. The truth is that too many of us neglect our health and this is leading to increasing levels of illness and early death. The evidence is all around.
  
  Public health is a sensitive subject. It's not easy to strike the right balance between "protecting" people's sensibilities and telling them hard facts about their personal behaviours that are ultimately shortening their lives. The Royal College of General Practitioners' call earlier this year for parents to be banned from smoking in cars carrying their children and for parents to act as role models by giving their children healthier food rather than sugary and fatty rubbish that leads to heart disease and diabetes both caused an outcry, with some even accusing me of attacking their civil liberties. I believe that parents who smoke in cars carrying small children are committing a form of child abuse; I suppose the same people also smoke at home in front of their children. Evidence from the US indicates that more young children are killed by parental smoking than by all unintentional injuries combined.
  
  Parents really do need to take more responsibility, but this should start even before conception. Many of these avoidable deaths can be linked to low birth weight as a result of mothers smoking while pregnant. Cot death, or Sudden Infant Death Syndrome, is also directly related to smoking. Other causes of death include lung infections, burning to death as a result of fires caused by cigarettes and asthma. Women who want to conceive, or are newly pregnant, need to take more responsibility as part of their commitment to the child they hope to carry.
  
  Too many people do not face up to the hard facts, as they perceive them to be an attack aimed, in particular at the poorer members of our society. But it is impossible to argue on medical or ethical grounds that such behaviour is acceptable. GPs are not spoilsports. We genuinely want people to be able to live healthy, fulfilling and productive lives. But every day we are confronted with the harm caused by smoking, excessive alcohol consumption and obesity.
  
  The roles for GPs are increasing. Every consultation is an opportunity to detect early-warning signs that prevent illness and disease. Sensible, timely and appropriate interventions can help make people aware of the potential risks they are taking. The Big Bolton Health Check is a great example. Since 2008, it has been offering free health screening to over-45s. More than 900 cases of potential diabetes and more than 2,000 people at high risk of heart disease have been identified who might previously have gone undetected. The initiative is also having a serious impact on reducing smoking rates and bringing down the number of admissions to hospital.
  
  The combination of evidence and example may be the solution. I practise a patient "mantra" of give up smoking, cut down on your drinking, eat more healthily and exercise regularly. I still have patients asking for liposuction and gastric bands on the NHS because media personalities have made surgery more acceptable than common sense. At least it shows that some people want to take control of their own lives, but it would be better if people didn't become fat in the first place. Ask a parent to give up smoking and they might refuse – but demonstrate how smoking at home will damage their children's lungs, leading to bronchial illness, asthma and a lifetime of ill health and they might start to see things differently. Similarly, drinkers who are confronted with the reality of their consumption might be spurred into cutting down rather than if they were just told to do it.
  
  I'm not suggesting that the GP profession can singlehandedly turn the situation around but we are certainly ready to play our part. Inspiration and support can sometimes come from the least unlikely quarters, as I discovered as a judge on the chief medical officer's awards.
  
  So please don't take offence if we tell you to lose weight or stop smoking or drinking. You need to face facts and take responsibility. Support is out there and it could save your life – and save the NHS a fortune.

  Source: The Observer, 08 August 2010
  Link: http://bit.ly/a6x0kF

• Smoking kills 8,000 a year in South-West

  A total of 8,019 people died of smoking related diseases in the South-West last year according to the 2010 Local Authority Health Profiles for England.

  This figure compares with 8,174 in 2009.

  The profiles also highlight that there are 8,210 expectant mums smoking during pregnancy in the South West, compared with 8,505 in 2009.

  Fiona Andrews, Director of Smokefree South West said: “The figures demonstrate that there are some encouraging trends in the South West.

  “However, we know that smoking is still the biggest preventable killer, and more work needs to be done to raise awareness of the harm caused by tobacco, encourage smokers to quit, and reduce the uptake of smoking among children.

  “These are all key priorities on Smokefree South West’s agenda.

  “We are involved at a range of levels from the ASSIST programme aimed at preventing the uptake of smoking in schools, through to our work in hospitals and pharmacies, which encourage people to quit in different settings.

  “We also work very closely with local NHS Stop Smoking Services.

  “Research has shown that smokers using the service are giving themselves the best chance to quit and with many locations across the South-West such as pharmacies, GP surgeries and workplaces, there is free help and support near you.

  Source: thisisthewestcountry, 09 August 2010
  Link: http://bit.ly/9zJFcb

• Thai tobacco officials 'took B62m bribes'

  Thailand Tobacco Monopoly officials have been accused of accepting bribes of over US$1.93 million (62 million baht) from US-based companies to ensure Brazilian-grown tobacco was sold locally, says the US Justice Department.

  The accusations came after two American tobacco companies agreed on Friday to pay nearly US$30 million to settle charges that they bribed foreign officials to get lucrative overseas tobacco sales contracts.

  Local officials could not be reached for comment yesterday.

  Universal Corp of Richmond, Virginia, and Alliance One International of Morrisville, North Carolina, face civil and criminal charges from the Securities and Exchange Commission and the Justice Department.

  Universal was accused of bribing officials in Thailand, Malawi and Mozambique, while Alliance One was accused of bribing officials in Thailand, China, Greece, Indonesia and Kyrgyzstan.

  Alliance One pleaded guilty to three counts of conspiring to violate the US's Foreign Corrupt Practices Act (FCPA).

  "The charges relate to bribes paid to Thai government officials to secure contracts with the Thailand Tobacco Monopoly, a Thai government agency, for the sale of tobacco leaf," the Justice Department said.

  Alliance One was formed in 2005 from the merger of Dimon Incorporated and Standard Commercial Corporation, two tobacco wholesalers.

  It buys, processes and sells tobacco to manufacturers worldwide.

  The guilty pleas relate to the conduct of employees and agents of foreign subsidiaries of both Dimon and Standard prior to the 2005 merger, the US Justice Department said.

  The department said that it had also filed two counts against Universal Brazil for conspiring to violate the FCPA by paying bribes to Thailand Tobacco Monopoly employees for the sale of Brazilian tobacco.

  It didn't say how many Thai officials were involved.

  The Justice Department said that from 2000 to 2004, Dimon, Standard and Universal Brazil sold Brazilian tobacco to the Thailand Tobacco Monopoly.

  No Thai officials were named by the department.

  "Each of the three companies retained sales agents in Thailand, and collaborated through those agents to apportion tobacco sales to the Thailand Tobacco Monopoly among themselves, co-ordinate their sales prices, and pay kickbacks to officials of the Thailand Tobacco Monopoly in order to ensure that each company would share in the Thai tobacco market.

  "To secure the sales contracts, each company admitted it paid kickbacks to certain Thailand Tobacco Monopoly representatives based on the number of kilogrammes of tobacco sold to the Thailand Tobacco Monopoly.

  "To obtain these contracts, Dimon paid bribes totalling $542,590 and Standard paid bribes totalling $696,160, for a total of $1,238,750 in bribes paid to the Thailand Tobacco Monopoly officials during the course of four years."

  Universal admitted paying $697,000 in kickbacks to the monopoly officials, the Justice Department said.

  It had agreed to pay a $4.4 million fine and retain an anti-corruption monitor for three years.

  Universal Corp said the company voluntarily reported the problems to authorities and that it has cooperated with the investigation.

  "We have absolutely no tolerance for this type of activity," chief executive officer George C Freeman III said.

  Source: Bangkok Post, 08 August 2010
  Link: http://bit.ly/9vdZGG