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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 1 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 2 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: 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. 3 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: 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. 4 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 5 6 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 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 7 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: 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 8 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: 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 9