Editorial

Citation

Caan, W. (2011), "Editorial", Journal of Public Mental Health, Vol. 10 No. 4. https://doi.org/10.1108/jpmh.2011.55610daa.001

Editorial

Article Type: Editorial From: Journal of Public Mental Health, Volume 10, Issue 4

Many health professionals in England are struggling with their responses to the NHS Bill, now lurching clumsily through parliament. Over the next two years, the entire health system here is due to change.

The associated Public Health strategy Healthy Lives, Healthy People (Department of Health, 2011) is alarming almost everyone working in this field. The editor of the Lancet (Horton, 2011) writes that “senior public health scientists” are unhappy: if many grey hairs mean seniority, then this ageing scientist agrees unambiguously. There is dismay that a proposed “Responsibility Deal” between private corporations and the Department of Health could corrupt the health of a generation. I will focus on child health, because the Lancet talks about both values and research in the same sentence and the good book commands leaders to:

Speak up for those who cannot speak for themselves, for the rights of all who are destitute. Speak up and judge fairly; defend the rights of the poor and needy (Proverbs 31, 8-9).

Because children may not see the big picture of epidemiology, it becomes our professional duty to speak up for their population health. For example, commercial vested interests take risks with their young lives by promoting drinking (Hastings et al., 2010). For everyone aged under 30, the impact of increasing alcohol on health is negative (Caan, 2000). For teenagers aged 14-17, the longitudinal study of young people in England shows even low levels of consumption cause problems: like any classic “determinant” of health, drinking is most likely to harm adolescents with vulnerable “social” circumstances (Department for Education, 2010). Adolescents and their parents do not see the risks from alcohol in the same way, for example the risk of teenage pregnancy, violence or sexually transmitted infections when drunk (Caan, 2011a). Recently, British hepatologists made a “wake-up” call for the rising physical morbidity attributable to alcohol, in response to an unprecedented accumulation of liver disease (Sheron et al., 2011). Rising morbidity with growing alcohol use increases pressure on mental health services, too. For example, across all other psychiatric diagnoses, the presence of any overlapping alcohol diagnosis doubles inpatient admissions over time (Caan and Crowe, 1994). We already know a great deal about the routes that take young people into harmful drinking (Advisory Council on the Misuse of Drugs, 2006). Bad habits that start early in life can leave a lasting impact on health. When both the mental and physical health of American men was followed up for 60 years, a history of alcohol abuse before age 50 was the strongest predictor of future, irreversible disability by age 70 (Vaillant and Mukamal, 2001).

By the age of 15 young people in the UK are more likely to have been drunk, compared to other European teenagers (UNICEF, 2007). Here, the Youth Taskforce has been wrestling with the “Friday-Saturday Night” phenomenon of weekly antisocial behaviour involving school age young people. Problems characteristically start early on Friday evenings, soon after schools close, with the comprehensive school in my own research site reporting many 15-year olds too hung over to attend their classes on Monday morning. For those boys and girls who drink the most, it is group behaviours that seem entrained to their alcohol use, in a recurring pattern. Well before the recent, widespread civil disorder in English cities (during August 2011) the Annual Public Health Forum was convinced (Roger and Caan, 2009) to make the link between youth drinking and crime a key policy priority. First understanding and then preventing harm to young people themselves is the focus of our “Victims and Vulnerable Young Persons Index”, now being tested in North Lincolnshire.

The interests of the brewers and distillers are easy to anticipate, but the political power over Government of the tourism and leisure industries is even stronger (Caan, 2001). As England approaches the 2012 Olympics, it grows ever harder to defend the rights of children against such power.

Festering for about a decade, our systematic failure of leadership in public health has spread (Caan, 2011b). Nonetheless, there are still transparent, public opportunities to advocate for health. For example, on 13 October 2011 the all party parliamentary group on alcohol misuse met to consider evidence for or against minimum alcohol pricing. In spite of obfuscation by some distillers and retailers of alcohol, the parliamentarians did their best to judge sensibly … next they even went off to a debate on the drinking culture within parliament itself (Caan, 2009)!

Sensible drinking

Printed tiny on its label:Almost illegibly,The bottle says:“Drink Responsibly”,But I sayThink responsibly -Or don’t drinkUntil you’re older,Able to holdDown your dose,Not getting drunkOr darkly morose.

Woody Caan