Download Public Health Newsletter June 2016 final

Bolton Council
Public Health
Bulletin
Issue 4, June 2016
Welcome to the Bolton Public Health bulletin. The purpose of this document is to keep you abreast of the
latest developments in the world of public health and how they relate to and affect the people of Bolton for
the period to 17th June 2016
www.boltonshealthmatters.org – Home of Bolton’s Joint Strategic Needs Assessment
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Tooth Decay in 5 Year Olds Reducing
The number of five-year-olds in England with tooth decay has dropped to its lowest level in almost a
decade, figures from the Public Health England Oral health survey of five-year-old children 2014-15 (here )
show. In 2008, nearly a third of five-year-olds in England - 177,423 in all - suffered tooth decay. By 2015,
this figure had dropped to a quarter of five year olds.
The pattern of dental health improvement among the age group shows the impact parents and carers can
have in establishing good dental care habits from an early age.
NICE Guidance (available here: here ) recommends brushing twice a day with fluoride toothpaste, ‘spit
don’t rinse’, reduce the intake of sugary foods and drinks and of course – visit the dentist regularly.
The Bolton Picture
The new figures for Bolton show that decay has continued its steady decline as per the trend in England;
whereas figures in the North West and in Greater Manchester show that rates of decay have remained
static between the last two surveys. This information can be seen in the table below.
Average number of decayed, missing and
filled teeth comparison (dmft)
England
2008/9
North West
2011/12
GM
2014/15
Bolton
0
0.5
1
1.5
2
2.5
www.boltonshealthmatters.org – Home of Bolton’s Joint Strategic Needs Assessment
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Services in Bolton to improve oral health currently include the oral health improvement team
(commissioned by Bolton Council and provided by Bolton NHS Foundation Trust) and an oral health
improvement strategy which both focus on improving oral health in the most deprived areas.
Some of the programmes delivered by this team in Bolton include:
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the Brush Bus (supervised brushing scheme in 69 venues)
Brushing for life packs (tooth brushing packs given our by health visitors)
Baby clinics – staff from the oral health improvement team attend to give advice
Swap it programme – sessions at Children ‘s Centre to swap bottles and dummies for tooth
brushing packs
Dental voucher scheme – vouchers for vulnerable children to access a dentist.
BHEYS award – Bolton healthy early years scheme, an award scheme for nurseries to support an
improvement in children’s health behaviours.
Oral health messages are also reinforced and delivered by the Children and Young People’s 5-19 Health and
Wellbeing Service
In the ‘Growing Up in Bolton 2015 Survey’,
 85% of respondents said they cleaned their teeth twice a day on the day before the survey and
 60% said they had visited the dentist in the previous year.
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Sugar Smart in Liverpool
Last January Change 4 Life launched its sugar smart campaign and app which aimed to inform people of the
health risks of consuming too much sugar, advising on ways of reducing sugar intake by suggesting
healthier alternatives (campaign information and the app can be found here )
The maximum daily amounts of added sugar (measured as 4g sugar cubes) for:
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4-6 year olds is 5 sugar cubes (19g)
7-10 year olds is 6 sugar cubes (24g)
11+ years is 7 sugar cubes (30g)
One of the key messages of the campaign is that around 30% of the sugar in children’s diets comes from
sugary drinks, such as fizzy pop, juice drinks, squashes, cordials, energy drinks and juice.
In early May, Liverpool City Council Public Health team made national headlines with the launch of their
sugar smart campaign focused on educating families about the levels of sugar within popular soft drinks.
Good oral health in childhood influences good oral health in adulthood. The campaign was aimed at
parents to support them to make healthier choices when making decisions about the drinks they give to
www.boltonshealthmatters.org – Home of Bolton’s Joint Strategic Needs Assessment
their children. It is hoped that this campaign will help parents achieve good oral health for their children by
reducing the amount of sugary drinks they consume.
The "Is your child's sweet tooth harming their health?" campaign names leading brands of soft drinks,
such as Lucozade, Coca-Cola, Tropicana, Capri-Sun and Ribena - warning how many sugar cubes are in each
drink:
 Lucozade (500ml) - 15.5 cubes
 Coca Cola (500ml) - 13.5 cubes
 Frijj chocolate milkshake (471ml) – 12.7 cubes
 Capri-Sun (330ml) – 8.25 cubes
 Tropicana orange juice (330ml) – 7.5 cubes
 Ribena (288ml) – 7.25 cubes
 Volvic flavoured water (500ml) – 5.75 cubes
The campaign is targeting hospitals, GP surgeries, children's centres and hospitals as well as the wider
community.
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www.boltonshealthmatters.org – Home of Bolton’s Joint Strategic Needs Assessment
European Immunisation Week: The importance of vaccines in our lives
To support European Immunisation Week Public Health England have produced a series of infographics
showing the impact that immunisation and vaccines have on our lives. The infographics are available here
The World Health Organisation cites that ‘The two public health interventions that have had the greatest
impact on the world’s health are clean water and vaccines’
How do vaccines work?
Vaccines are preventative, that is, they only protect the individual before they get an infectious
disease. When an individual is vaccinated, the processes in the immune system are stimulated to
mimic the body’s natural immunity. These processes occur without causing the damage that an
infection usually causes because the vaccine contains the antigen of the infectious disease, or a toxoid
(an inactive version of a toxin) in an inactive, safe form. These infectious agents have been inactivated
by being killed or denatured by heat, radiation or other harmful conditions. The antigen is the same
but the microorganism can no longer cause the infectious disease.
Vaccines provide immunity by stimulating the immune system to produce antibodies to fight a
particular infection or prevent the effects of a toxin. These antibodies stay in the body and provide
long term protection. Antibodies fight a particular infection or toxin by identifying a matching
antigen. Antigens are a pattern or structure found on the microorganism or toxin, and the antigen is a
complimentary match for the antibody that will be produced.
If an individual has not been vaccinated against a disease and they have contact with it, they will
usually acquire some natural active immunity through exposure to antigens of the microorganism or
toxin. However, there are risks associated with contracting an infection as some can leave the
individual with long term complications, or worse, cause death. Artificial active immunity occurs
through vaccination or inoculation.
If enough of a population is vaccinated, herd immunity is attained. Herd immunity in a population
prevents outbreaks of an infection. This is due to the inability of the disease to infect vaccinated
individuals and through the inability for unvaccinated individuals to come into contact with the
disease due to its decreased prevalence. It is important to maintain herd immunity as some people are
unable to have vaccinations. Individuals who may not be able to have a vaccine include those who are
immune-compromised, individuals with allergies to the components of vaccines and very young
children.
Vaccines through life
A number of routine vaccines are offered to all across the life course and are illustrated in the infographic
below. The most up-to-date full vaccination schedule can be accessed here: here
www.boltonshealthmatters.org – Home of Bolton’s Joint Strategic Needs Assessment
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Additional vaccines are offered for some special groups eg pregnant women, people with long term
conditions or health care workers. Other vaccines are given to those travelling outside the UK to offer
protection against some of the serious diseases found in other parts of the world e.g. yellow fever.
The impact of vaccines
 Globally more than 4,000 children per year died of diphtheria prior to the introduction of the
vaccine, there were two deaths in Europe from the disease in 2012.
www.boltonshealthmatters.org – Home of Bolton’s Joint Strategic Needs Assessment
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Before the introduction of the vaccine more than 1 in 5 child deaths worldwide were caused by
measles.
In 1979 the World Health Organisation declared that smallpox had been eradicated.
The table below shows the impact that the introduction of vaccines has had on several diseases in England
and Wales, in many cases almost entirely eradicating them, and subsequently reducing deaths from the
diseases particularly in children.
Disease
Diphtheria
Whooping Cough (Pertussis)
Measles
Hib (Haemophilus influenza
type b)
Men-C
(Group C invasive
meningococcal disease)
Invasive Pneumococcal
disease caused by 13
vaccine serotypes
Total Number of
Cases per year
before vaccine
introduced
50,804
92,407
460,407
862
Year
Vaccine
Introduced
2014 total
laboratory cases
Percentage
Reduction
1942
1957
1968
1992
1
3506
130
12
99.9%
96%
99.9%
99%
883
1999
28
97%
3552
20061
858
76%
The Bolton Picture
Bolton has very high population coverage of virtually all vaccinations, with rates higher than both the
regional and national average.
The exception to this is uptake of the flu vaccine in the 65 years+ age group where, although the Bolton
rate (74.1%) is higher than the national average (72.7%), Bolton lags behind the rate of its Greater
Manchester neighbours (75.4%)
Local areas should aim to have at least 90% of children immunised in order to give protection both to the
individual child and the overall population. The MMR immunisation rate is higher than 90%. The
immunisation rate for diphtheria, tetanus, polio, pertussis and Hib in children aged two is higher than 90%.
A higher percentage of children in care are up-to-date with their immunisations compared with the England
average for this group of children.
Local vaccination rates are monitored by the local Health Protection Forum to ensure continued high levels
of uptake and to identify ways of promoting uptake of those vaccinations where coverage is lower.
www.boltonshealthmatters.org – Home of Bolton’s Joint Strategic Needs Assessment
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UV Awareness in the Summer
As the summer season fast approaches, Public Health England has produced a blog (available here)
encouraging us to be more aware of Ultraviolet radiation, (or UV as it more commonly known) and its
effects. The key messages are:
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Sunburn and even a tan is a sign of over-exposure to UV and this can lead to skin cancer
Although we can all burn from over-exposure to UV, how quickly we’re affected depends on our
skin type People with darker skin can tolerate more than those with lighter skin types
You can still burn on a cloudy day
Although it can take a while, the body can acclimatise to increases in UV exposure
Protecting ourselves from UV is easy: pop on a wide-brim hat, slip on a shirt, slap on suncream (at
least SPF 15 with UVA protection in the UK), avoid being out in the sun too long between 11am3pm, UV can damage the eyes too so wear wraparound sunglasses with UV protection
Some UV exposure is good for us as it helps our bodies makes Vitamin D. Most people will make
enough vitamin D if they have a short daily period of sun exposure around midday without
sunscreen during the summer months.
For more information on how to be Sun Safe check out NHS Choices guidance by clicking here
Skin Cancer
Most skin cancers are caused by exposure to the sun. This may be long-term exposure or short periods of
overexposure. This is because UV light from the sun damages the DNA in our skin cells.
There are two main types of skin cancer: basal cell carcinoma (BCC) and squamous cell carcinoma (SCC).
People with a history of sunburn or overexposure to the sun in childhood have a greater risk of developing
BBC. This won’t usually show up until many years later. Sun exposure over your lifetime is more significant
in developing SCC.
Skin cancers may look like
 A spot or sore that does not heal within 4 weeks
 A spot or sore that itches, hurts, is scabbed or crusty, or bleeds for more than 4 weeks
 Areas where the skin has broken down (an ulcer) and doesn't heal within 4 weeks, and you can't
think of a reason for this change
The earlier a cancer is picked up, the easier it is to treat it as this increases the chances of the treatment
being successful. It is important that medical advice is sought once symptoms are noticed.
The Bolton Picture
 Incidence of skin cancer in Bolton is lower than is average for the North West region, but is still
higher than England;
 Bolton is higher than average for its statistical peers, and many peer local authorities have rates
below the national average;
 Bolton receives fewer hours of sunshine than is average for England, but the town has a much
higher sunbed outlet density. For more information on safe sunbed use please click here
 Skin cancer incidence rates are higher in the areas which are less deprived.
www.boltonshealthmatters.org – Home of Bolton’s Joint Strategic Needs Assessment
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Active travel: a briefing for local authorities
This briefing, produced by Public Health England has been written for transport planners, others concerned
with the built environment, and public health practitioners and can be accessed here.
The paper looks at the impact of current transport systems and sets out the many benefits of increasing
physical activity through active travel. It suggests that while motorised road transport has a role in
supporting the economy, a rebalancing of our travel system is needed.
This guide suggests a range of practical action for local authorities, from overall policy to practical
implementation. It highlights the importance of community involvement and sets out key steps for
transport and public health practitioners
Some key messages from this report are:
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physical inactivity directly contributes to 1 in 6 deaths in the UK and costs £7.4 billion a year to
business and wider society;
the growth in road transport has been a major factor in reducing levels of physical activity and
increasing obesity;
building walking or cycling into daily routines are the most effective ways to increase physical
activity;
short car trips (under 5 miles) area prime area for switching to active travel and to public transport;
health-promoting transport systems are pro- business and support economic prosperity;
They enable optimal travel to work with less congestion, collisions, pollution, and they support a
healthier workforce
Walking and cycling are good for our physical and mental health. Switching more journeys to active travel
will improve health, quality of life and the environment, and local productivity, while at the same time
reducing costs to the public purse. These are substantial ‘win-wins’ that benefit individual people and the
community as a whole.
Allied to this is an interesting piece of research by Tainio et al (available here). This research looked at the
risk-benefit trade off from active travel in poor quality environments such as urban areas. The report
concluded that benefits from active travel generally outweigh health risks from air pollution and therefore
should be further encouraged. When weighing the long-term health benefits of physical activity against
possible risks from increased exposure to air pollution, promoting cycling and walking is justified in the vast
majority of settings, that only in the cities with the worst air pollution would active travel not be beneficial.
The Bolton Picture
The 2011 census showed that:
 70% of people who live and work in Bolton use private transport to get to work (live in Bolton work
in GM 75%)
 11% use public transport (live in Bolton work in GM 12%)
 18% of those who live and work in Bolton walk or cycle to work (live in Bolton work in GM 13%)
www.boltonshealthmatters.org – Home of Bolton’s Joint Strategic Needs Assessment
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