CLOSING SPEECH TO CONFERENCE

Transcription

1 CLOSING SPEECH TO CONFERENCE SUZI LEATHER Thank you very much for inviting me to give the closing speech for this important conference and it is great to see the re-emergence of interest in nutrition on the part of health professionals. With so many conflicting demands on your time during your training and now your work for the Health Service, it is sometimes hard to remember the vital contribution of nutrition to health throughout the whole of life, including in the womb. Historically health improvement and public health with the NHS have had a low status, and within public health, food and nutrition have received less attention. Now we recognise that nutrition has a vital part to play in achieving the government's health targets for cardiovascular disease and cancer, but we also recognise that there are other factors such as income and education which are important determinants of health. Positive moves in the past have included adding an element of nutrition education into the medical curriculum, and increasingly the professional colleges have been taking an interest in nutrition, particularly from the point of view of prevention. But we know that a patient's nutritional status may barely register as a blip on the radar of the average GP as he or she rushes through a series of five or ten minute consultations. It is time to spread the message more widely, and this conference has provided a comprehensive state of the art review of the latest knowledge in all areas of nutrition. As you know, until recently government responsibility for food lay with the Ministry of Agriculture, Fisheries and Food (MAFF). While MAFF continues to have responsibility for food production, the Food Standards Agency has taken over responsibility for food safety issues and nutrition since April Safety has been the dominant concern in food debate

2 Closing speech to conference 163 most recently, indeed it was the BSE scandal which led to the setting up of the Food Standards Agency. But, put in perspective, mortality from problems associated with nutrition far outstrips that from food poisoning. The complexity comes from the fact that chronic diseases are multifactorial in origin and the contribution that improved nutrition can make may vary a great deal depending on the disease. In addition to which, we still do not fully understand the true role of some foods or components of foods in preventing degenerative conditions. The Food Standards Agency has very specific responsibilities in relation to nutrition, which include collecting and communicating up-to-date information on food composition, and providing a definition of a balanced diet for use in health education material. We can provide practical guidance in relation to nutritional aspects of the food chain from farm to fork. The Food Standards Agency funds jointly with the Department of Health the National Diet and Nutrition Surveys. The Survey of Young People was published in June 2000, and provides an extraordinarily detailed and revealing portrait of the dietary habits and nutritional status of the participants, who were aged between 4 and 18 years. We are extremely grateful to these young people for making the commitment to collect full 7 day weighed records and provide their body measurements, blood and urine samples. The findings highlighted that there are significant numbers of young people with low fruit and vegetable intake ± during the survey week more than half of young people had not eaten any citrus fruits or leafy green vegetables. Physical activity levels fell with age, and teenage girls turned out to be the real couch potatoes which is a particular concern since 36% of girls also reported smoking and we know that both of these factors predispose to osteoporosis later in life. The surveys provide us with data on socio-demographic factors which can militate against the taking up of the healthy eating messages which we know so well, but which are often inaccessible, particularly to those with the worst health and life chances. Food choice is not just determined by education or knowledge but also social class, income and access. We found that children from low income families had a different pattern of food consumption, and in particular were less likely to consume raw and salad vegetables, fruit juice and soft fruits. On the other hand, they were less likely to eat cream and butter. We found that vitamin C levels in the blood increased with income, and although deficiency by the standard definition was rare, it may well be that this is still not satisfactory since we are beginning to realise that to prevent degenerative diseases, higher

3 164 Nutrition and Health intakes of nutrients such as vitamin C are needed than those normally required just to prevent classic deficiency diseases. The Food Standards Agency also funds several nutrition research programmes inherited from the Ministry of Agriculture, Fisheries and Food. Through the funding of research the Agency will continue to contribute to the growing body of knowledge on, for example, components of fruits and vegetables which may contribute to disease prevention. We will also be looking at developing new methods for assessing the diets of those on low incomes, with a view to a new diet and nutrition survey of low income families. Some new research will also flow from the work of the new Scientific Advisory Committee on Nutrition which is now being set up jointly by the Food Standards Agency and the Department of Health. The Food Standards Agency is committed to working closely with government bodies which are also involved with nutrition, including the Department of Health, the Department for Education and Employment, and the Health Development Agency. Staff of the Food Standards Agency also work closely with nongovernmental organisations such as the British Nutrition Foundation. Through the funding of research under the Food Acceptability and Choice programme we are concerned with exploring, for example, ways in which we might intervene with youngsters to prevent obesity developing later in life, discovering whether the concept of food deserts is genuine and looking at ways to encourage people to develop and enjoy cookery skills. Good nutrition is about much more than knowing your vitamins and minerals. The point now, as the title of this section of the conference (From research to practice: implementation) suggests, is how do we move from the realm of the laboratory to the real world. The public are bombarded with a huge diversity of information about food and nutrition, some of which is questionable. Sometimes healthy eating messages have been perceived as confusing or too difficult to put into practice. This is a sensitive area since healthy eating messages from government compete with concern about the `nanny state' curbing individual choice, and commercial interests of food and drink manufacturers. The benefits of dietary change are not immediate in our `instant' society. So what is the role of the health sector? Let's take General Practice. Recent bad publicity has no doubt made the profession feel beleaguered, but let's

4 Closing speech to conference 165 remind ourselves of the strengths of the primary care team. There is no doubt that General Practice is still a source of respected advice for the general public; 75% of the population see their GP in any given year, and 95% over a five year period. Members of the primary care team provide one-to-one contact and an opportunity for giving preventive advice which is personalised. General Practitioners still have the unique strength of being able to get to know not just the individual but often the entire family over two or three generations, although this is more difficult where populations are more mobile. The primary care team also includes community health professionals of all kinds, including the health visitor, community midwife, dietitians, school nurses, community dentists, pharmacists and many others, all of whom have the chance to get to know people and have the advantage of understanding local conditions and the factors that will help individuals make the best choices in order to lead healthy lives. All of these professionals see people at times in their lives when they may well be open to change, for example during pregnancy, when women are otherwise normally healthy but for the first time in some instances are focused on what is best for their unborn child which is often, as it happens, best for the mother as well. On the down side, many people do not think about change until it is too late, when they are ill, and the medical setting may provide only damage limitation. But in some cases, better late than never, and substantial improvements in life expectancy and quality of life can be gained by secondary prevention after a heart attack or stroke, although we know that this may mean a multi-pronged approach using drugs as well as healthy living advice such as increasing exercise and improving diet. As a health professional, whether based in hospital or in the community, you can never assume that your client or patient is adequately fed or has the means to provide an adequate diet for themselves or their children. It is a sad fact that one in three children in Britain lives in poverty, that is to say, they live in households whose income is less than half average earnings. Many of these live in lone parent households, the majority of whom are on Income Support. The consequences of this are enormous, at the same time physical, mental and social, from poor iron status in infancy leading to slower development, to social stigma from being different to others. With recent advances in the Health Service, nutrition is being kept on the agenda via Health Improvement Programmes. Government initiatives

5 166 Nutrition and Health such as Sure Start and the New Children's Fund for school age children have already been addressing some of the problems associated with poverty in childhood. There is no doubt that newly established Primary Care Groups and Trusts will also have an interest in prevention through their key role in population health development. The new NHS Plan has also identified nutrition as a key factor in reducing ill health, in conjunction with improved health services. This will involve, for example, joint working between the Food Standards Agency and the Department of Health to work towards reducing the salt content of manufactured foods. This is a population-based approach which primary care professionals would not be able to address since 75% of the salt we consume is already added to pre-prepared foods and consumers would not be able to avoid this with simple healthy eating advice. This illustrates well how no single approach can solve the problems we are addressing. I believe that the time is right to give diet further prominence in our work. As an organisation the Food Standards Agency will be working closely with others to improve the evidence base for targeted research and effective interventions, for example by working with the Health Development Agency. We can work towards improving food labelling, and giving clearer advice to consumers. In Scotland and Wales the Food Standards Agency is working closely with their Parliament and Assembly to bring improvements to areas of the UK with particularly marked problems such as the highest rates of coronary heart disease in the world. We need to think about developing guidance on models for local dietary improvement, perhaps by looking at best practice in community involvement and consultation, and evaluating diet and nutrition goals at HImP level. Health Improvement Programmes provide a start from which local partnerships can be identified and strengthened to deliver local and hence national targets. We will continue to look at the population-based approaches which will complement your own work with individuals, because after all that is what it all boils down to: the patient or client sitting in your surgery or in their own home. Don't underestimate the power of a single consultation: we know that a few minutes with a GP can persuade someone to stop smoking; there is certainly potential to influence people at an individual level given the right approaches. Together we can take on this responsibility with enthusiasm. It remains for me to thank the organisers once again for inviting me to close this excellent conference, and I hope that you have all found it a fruitful event, so to speak!