Prevention intention

Prevention intention

A Vision for Prevention

Matt Hancock, UK Secretary of State for Health and Social Care since July 2018, launched his prevention vision on 5 November.

His other priorities are to advance health technology and provide better support for the health and social care workforce. He sees prevention as having two aspects. Partly it is about keeping well physically and mentally, to prevent ill health, but  also about the environment around people, their lifestyle choices and how existing health conditions are managed. The aims are for the average person to have 5 more years of healthy independent living by 2035, and to reduce the gap between the richest and poorest. At present there is a large discrepancy in spending with £97 billion (public money) spent on treating disease and £8 billion on prevention across the UK!

The proposed actions in the vision  are:

  • “Prioritising investment in primary and community healthcare
  • Making sure every child has the best start in life (our emphasis)
  • Supporting local councils to take the lead in improving health locally through innovation, communication and community outreach
  • Coordinating transport, housing, education, the workplace and the environment – in the grand enterprise to improve our nation’s health
  • Involving employers, businesses, charities, the voluntary sector and local groups in creating safe, connected and healthy neighbourhoods and workplaces”

The Department of Health and Social Care’s (DHSC) paper is called ‘Prevention is better than cure: Our vision to help you live well for longer‘.

It states there is strong evidence that prevention works and recognises that a healthy population is both vital for a strong economy and for reducing pressure on services like the NHS (almost 10% of the national income is spent on healthcare). Average life expectancy is now 81 years, helped by:

  • advances in healthcare
  • changing attitudes so there is less stigma with some conditions
  • improvements in the environment, at home, work and in neighbourhoods
  • antibiotics and mass vaccination
  • public health programmes.

However, there are major challenges in the huge discrepancies between areas – ‘A boy born today in the most deprived area of England can expect to live about 19 fewer years in good health and die nine years earlier than a boy born into the least deprived area.’ (p.7)

Duncan Selbie, Chief Executive of Public Health England, welcomed the change of focus to more emphasis on prevention and pointed out the need for collaborative working – NHS, national government, local government, voluntary and community sector, and industry.  It will be important to monitor industry involvement to ensure that it does not create conflicts of interest, undermining health. Infants, young children, pregnant and breastfeeding mothers are particularly vulnerable, which is why the World Health Organisation developed guidance to protect them from conflicts of interest (WHO 2016 Guidance on the Inappropriate Promotion of Foods for Infants and Young Children) and other inappropriate commercial influence (International Code of Marketing of Breastmilk Substitutes, 1981, and subsequent WHA resolutions).

Improvements will depend both on encouraging individuals to choose healthy lifestyles and manage their own health, and expecting local authorities to take the lead in improving the health of their communities. The challenges of smoking, mental ill health, obesity, high blood pressure and alcolol-related harm are mentioned, along with the benefit of having a more personalised approach to health.

The section on ‘Giving our children the best start in life’ (p.20) mentions healthier pregnancies, improved language acquisition, reducing parental conflict, improving dental health, protecting mental health and  schools involvement, but infant feeding is not mentioned at all! 

However, in the Parliamentary debate on the vision (Prevention of Ill Health: Government Vision) on 5 November, Alison Thewliss MP made the case for supporting breastfeeding by investing in the Baby Friendly Initiative to bring all maternity and community services up to the minimum standard. Matthew Hancock’s reply sounds positive: ‘The earlier that we can start with this sort of strategy of preventing ill health the better, and there is a lot of merit in a lot of what the hon. Lady said.’

 

‘Prevention, Protection and Promotion’ at Public Health England

Earlier in the year (March 2018), Professor Viv Bennett, the Chief Public Health Nurse, and Professor Jane Cummings, the Chief Nursing Officer, came together to launch a campaign on the ‘3Ps –  Prevention, Protection and Promotion’, which is about actions to improve public health and reduce health inequalities. Breastfeeding is mentioned in the Maternity Transformation Campaign and Better Births and there appears to be increased govenment commitment to the key role breastfeeding plays in improving public health.

 

Directors of Public Health have a key role

The DHSC paper expects Directors of Public Health to ‘play an important leadership role’ (p.15). As an example, the Annual Report of Croydon’s Director of Public Health, published in mid-November, We are Croydon: Early Experiences Last a Lifetime, focusses this year on the first 1000 days of a child’s life.

It includes three breastfeeding recommendations:

  • Reset targets for increasing breastfeeding rates at 6 to 8 weeks and 6 months across the Borough and within particular localities
  • Achieve level 3 of the UNICEF Baby Friendly award
  • Turn Croydon into a breastfeeding friendly Borough, so women feel comfortable breastfeeding when they are out and about

 

How can progress on prevention occur unless it starts at the beginning – with infants? Will other Directors come up with similar recommendations?

 

Make London a ‘Baby-Friendly’ city

The Mayor of London, Sadiq Khan, aims to “make London a ‘Baby-Friendly’ city” in the London Food Strategy. This strategy aims to increase the health of all Londoners from infancy onwards, including supporting and normalising breastfeeding across London Transport and across government buildings and workplaces, and encouraging all London boroughs to become Unicef UK Baby Friendly-accredited in maternity and community services.

 

The UK government is due to publish a Green Paper on Prevention in 2019 to set out more detailed plans and, together with the NHS Long Term Plan, which is due to be published soon,  is relevant to a future with better health for all.

What can YOU do?
Sign up for our mailing list and to volunteer in our campaigns here!

 

30. Photo for WBTi MAINN presentation
Patricia Wise is an NCT breastfeeding counsellor and a member of the WBTi Steering Group.

Breastfeeding and the First 1000 Days: the foundation of life

Breastfeeding and the First 1000 Days: the foundation of life

Breastfeeding: The Foundation of Life

The First 1000 Days of Life (from conception to the age of two years) are a critical window in a baby’s development. The 1000 Days concept was first widely used by the World Health Organisation and UNICEF, and there are currently numerous campaigns building on that theme.*

There is currently an inquiry into the First 1000 Days by the UK Parliamentary Select Committee on Health and Social Care. This blog brings together a few of the key concepts and resources on the importance of breastfeeding during the First 1000 days.

A joint supplement on the importance of breastfeeding in the first 1001 Days was produced by the UK breastfeeding organisations in 2015, which summarises much of the evidence.

A focused briefing on the the role of breastfeeding on infant brain growth and emotional development can be found here.

 

Breastfeeding: cornerstone of the First 1000 Days

Human babies are born extremely immature compared to other mammals; they are completely dependent on their mothers for milk, comfort and warmth.

  • “A newborn baby has only three demands. They are warmth in the arms of its mother, food from her breasts, and security in the knowledge of her presence. Breastfeeding satisfies all three.” ~ Grantly Dick-Read

Scientific research has continued to underscore the vital role that breastfeeding and breastmilk play in the development of the human infant. See our WBTi blog series for this year’s World Breastfeeding Week, from 31st July – 7th August 2018 for a review of the myriad ways that breastfeeding influences human development.

 

Breastfeeding: more than just food

This is the title of a series of blogs by Dr Jenny Thomas which focuses on some of the ways that breastfeeding contributes to immune development and more. Beyond physical health and development, however, breastfeeding also plays a key role in the healthy mental and emotional development of the infant. Breastfeeding provides optimal nutrition for the first months and years of life, alongside suitable complementary food after six months, but it also supports the development of the child’s immune system and protects against a number of non-communicable diseases in later life as well.

The World Health Organization commissioned high level reviews on a range of health and cognitive outcomes which were published in a special issue of Acta Paediatrica in 2015; these formed the foundation of the Lancet Series on Breastfeeding  which was published in 2016.

 

The impact of breastfeeding on maternal and infant mental health and wellbeing.

Breastfeeding can help strengthen mother and baby’s resilience against adversity, and can protect infants even when their mothers suffer from postnatal depression. It supports optimal brain growth and cognitive development. Unfortunately, if mothers don’t receive the support they need with breastfeeding, this can significantly increase their risk of postnatal depression. A summary of evidence can be found here.

The role of breastfeeding in protecting maternal and infant mental health is often poorly understood – mothers who are struggling need skilled support to resolve breastfeeding problems if they wish to continue breastfeeding

 

What does the future hold?

It is essential that policy makers, commissioners, and researchers understand the evidence and importance of breastfeeding, so that women who want to breastfeed get any support they need. The WBTI report outlines major policies and programmes that national infant feeding strategies need to include; other research on the psychological and cultural influences on mothers’ infant feeding decisions will help policy makers to develop sensitive and sound policies and programmes to support all families.

In the end, it will be essential that families themselves are heard, in order to create the support systems that our society needs.

 

 

*Unfortunately a number of infant milk and baby food companies have jumped on the “1000 Days” bandwagon too, despite the fact that breastfeeding is the centrepiece of the original 1000 Days concept, and replacing breastmilk with formula or baby food actually removes that fundamental building block from a baby’s development.

 

 

 

Helen Gray IBCLC photoHelen Gray MPhil IBCLC is Joint Coordinator of the World Breastfeeding Trends Initiative (WBTi) UK Working Group. She is on the national committee of Lactation Consultants of Great Britain, and is also an accredited La Leche League Leader. She is a founding member of National Maternity Voices. She represents LLLGB on the UK Baby Feeding Law Group, and serves on the La Leche League International special committee on the International Code.

Shared Parental Leave and the right to breastfeed on return to work

Shared Parental Leave and the right to breastfeed on return to work

Guest blog by Rosalind Bragg, Director of Maternity Action

Maternity Action’s work centres on protecting the rights of pregnant women and new mothers in the workplace. As a member of the WBTi Core Group, Maternity Action was responsible for gathering most of the information on Indicator 4, “Maternity Protection in the workplace.” They have very kindly allowed us to republish their blog on the current status of breastfeeding in the workplace here during UK National Breastfeeding Weeks. 

The original blog can be found on Maternity Action’s website here, along with a range of resources on maternity rights. Follow Maternity Action for updates on their campaigns on this and other important maternity rights.

 

The right to breastfeeding breaks and facilities is a gap in the policy framework to support new parents to balance work and family responsibilities.  The current review of Shared Parental Leave policies is an opportunity to remedy this omission.

On May 15, we presented to the All Party Parliamentary Group on Infant Feeding focusing on Maternity Action’s campaigning against pregnancy and maternity discrimination and the particular challenges facing breastfeeding women in the workplace.

Women in the UK who wish to combine work and breastfeeding have very weak legal protections.  Health and safety regulations provide breastfeeding women with the right to a place to rest and to a health and safety risk assessment.  While some employers may offer regular breaks to breastfeed or express milk and a private space in which to do so, these are not required by law.

For most women, flexible working requests are the only legal avenue to seek adjustments to their working conditions to facilitate breastfeeding.  Employers must seriously consider flexible working requests but can refuse them if they have a good business reason for doing so.  On our advice line, we regularly hear from women struggling to negotiate flexible working arrangements on return to work.  Employers can, and often do, reject reasonable requests for adjustments to working conditions.

Many of the UK’s trading partners have more constructive approaches to balancing breastfeeding and work.  Germany provides paid breastfeeding breaks and facilities while the US provides unpaid breaks.  Australia offers an alternative form of protection by prohibiting discrimination on grounds of breastfeeding.  These are just a few examples.  It is unsurprising that the recent World Breastfeeding Trends Initiative (WBTi) review rated the UK 67th out of 91 countries on its law, policy and programmes that support breastfeeding women.

The current review of the Shared Parental Leave scheme provides an opportunity for Government to reconsider its approach to breastfeeding and work.  In 2013, when debates were underway on the new scheme, Maternity Action campaigned for a statutory right to breastfeed on return to work.  While this did result in ACAS guidance on the issue, legal protections were not forthcoming.

It is extraordinary that a scheme to encourage parents to share leave from their child’s first weeks should pay so little attention to breastfeeding.  The Department of Health recommends exclusive breastfeeding for six months and breastfeeding in conjunction with solid food thereafter.  Given the absence of legal protections for breastfeeding women, the vast majority of women who share leave will need to stop breastfeeding prior to return to work.  This reduces the number of women prepared to share leave with their partner and also contributes to the UK’s low rate of breastfeeding.

Whether women breastfeed or not, and for how long, is a decision for each woman to make.  The role of the law is to remove impediments to breastfeeding, enabling women to make decisions based on their own needs, not the convenience of their employers or other equally irrelevant factors.  It is long past time that UK employment law caught up with that of its trading partners and provided formal legal protection for breastfeeding on return to work.

 

 

Protecting Infants and Young Children: WBTi Forum on Planning for Emergencies in the UK

Protecting Infants and Young Children: WBTi Forum on Planning for Emergencies in the UK

On Tuesday 28th, Dr Ruth Stirton of the University of Sussex joined forces with the World Breastfeeding Trends Initiative (WBTi) Steering Group, along with Marie McGrath of the Emergency Nutrition Network, to present on the topic of safe provision for feeding infants and young children in emergencies in the UK. This WBTi UK first anniversary forum was hosted by Alison Thewliss MP, chair of the All Party Parliamentary Group on Infant Feeding and Inequalities, at the Houses of Parliament.

Participants included infant feeding specialists and policy makers, emergency planners, international academics, and third sector organisations such as UNICEF UK Baby Friendly Initiative and Save the Children.
We heard from Clare Meynell and Helen Gray (WBTi UK) on the findings, gaps and recommendations from the WBTi UK report surrounding infant feeding in emergencies. Ruth Stirton presented on the legal and regulatory framework and the minimal place of infants and young children in the current framework. Marie McGrath then described the recently published 2017 Operational Guidance on Infant Feeding in Emergencies, and explored how it might be adapted to the UK context.

WBTI Forum 2017 discussion mapping LCGB Faulkner

The audience engaged in lively group discussion, considering:

  • the issues in the immediate response phase
  • how best to support formula feeding families in emergency situations
  • mapping the existing local capabilities that emergency plans could call upon
  • issues surrounding communication with the public and front line responders about how best to support infants and young children in emergencies
  • the wider policy framework and how best to ensure that infants and young children are specifically provided for
  • issues for the longer term recovery phase after the emergency

A report will be published in 2018 making recommendations for improvements. If you would like to contribute written comments to the report, please look at the presentations and group materials and send comments by email to Ruth Stirton r.stirton@sussex.ac.uk

WBTi Forum 2017 and GPIFN THewliss
WBTI Steering Group Helen Gray, Patricia Wise, Alison Spiro, (Clare Meynell in absentia), with host Alison Thewliss MP, and Dr Louise Santhamum and Dr Rosemary Marsh (GP Infant Feeding Network) and Dr Ruth Stirton (University of Sussex Law School)

Ruth Stirton, University of Sussex

Helen Gray, WBTi UK

Clare Meynell, WBTi UK

Alison Spiro, WBTi UK

Patricia Wise, WBTi UK

 

References and resources:

Presentations and group discussion materials

Storify with tweets from the event at Parliament:

Operational Guidance on Infant Feeding in Emergencies 

World Health Assembly Resolution 63/23 

WBTi UK report

 

Blog posts:
Overview of WBTi Indicator 9, Infant Feeding in Emergencies

Our Guest blog on UNICEF UK Baby Friendly 

Safely Fed UK Facebook page and social media campaign 

 

 

WBTi UK report – first anniversary celebration – a Forum

WBTi UK report – first anniversary celebration – a Forum

It’s a year since the first WBTi UK report was launched in November 2016 at the Houses of Parliament, giving the first snapshot of the state of breastfeeding support in the UK across the indicators. The report has been used as a basis to advocate for improvements in legislation, in strategy, and in training. It has been shared with MPs, with government ministers, as well as shared widely throughout the breastfeeding community through our website.

During the year, we have hosted monthly blogs on our website, focussing on the various indicators in turn. We have an active social media planning group that publicises the WBTi findings, our blog and activities. The team have also produced numerous journal articles, posters and conference presentations in the UK and beyond. Our talented team of volunteers have also developed a video  about our findings. We continue to contribute to ongoing consultations about improving health professional training in infant feeding

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Policy Forum: Protecting Infants in UK Planning for Emergencies

On November 28th 2017, we will be holding a policy forum at the Houses of Parliament, in collaboration with Ruth Stirton of the University of Sussex and hosted by Alison Thewliss MP: “Protecting Infants in UK Planning for Emergencies.” This event both celebrates the anniversary of the report and aims to achieve change in Indicator 9, “Infant and young child feeding during emergencies,” which is the policy with the lowest scores across the UK. At present, there are no UK-wide or national strategies addressing the issue and it is not explicitly mentioned in local planning.

Unicef UK Baby Friendly Initiative

The jewel in the crown of breastfeeding support in the UK is the Unicef Baby Friendly Initiative. All maternity units in Scotland and Northern Ireland are accredited and most in England and Wales are working towards it. Many community NHS trusts and boards are also on the ladder towards accreditation. Some neonatal units, university midwifery and health visiting/specialist community public health nursing courses are also involved. All are helping to raise the standards of infant support provided by these health professionals.

Cuts to breastfeeding support around the country

Sadly, the WBTi assessment found that cuts in infant feeding lead posts, drop-ins and peer support programmes as well as specialist services were occurring and this has continued. For example, Blackpool’s service was decommissioned in June and the service in Kent is under threat. It appears that there is an assumption by some commissioners that health visitors can provide a sufficient service. Health visitors do have a responsibility to provide effective support with infant feeding, and should do so at statutory visits and other contacts. However, a significant number of mothers also require specialist support, which needs time as well as skill, and all mothers can benefit considerably from the social support that trained peer supporters can provide. It seems it is not well understood how challenging some breastfeeding situations are and the amount of training required to help effectively in those situations.

Ask YOUR MP to join the Call to Action!

These cuts in services for women and babies are likely to have a negative impact on Baby Friendly accreditations. Unicef UK is holding an event for MPs at the Houses of Parliament on December 5th, asking them to pledge their support for breastfeeding. How would it be if every current MP were contacted? Are you willing to contact your MP?

 

 

 

Protecting all infants in emergencies: Indicator 9 in the WBTi report

Protecting all infants in emergencies:  Indicator 9 in the WBTi report

The World Breastfeeding Trends Initiative (WBTi) assessment looks at the state of national policy, programmes and planning around infant and young child feeding (IYCF) in each country.

Indicator 9 focuses on national planning for the protection of infants and young children in case of emergency: is there a strategy in place to ensure that suitable nutrition and support is quickly put in place for families in the event of a disaster?

Infants and young children are our most vulnerable citizens in any emergency situation. They need protection, as their immune systems are immature, they have specific nutritional requirements, and they can’t wait several days for an emergency response to meet their needs, especially in a high-risk setting.

Disasters and emergencies in the UK

The UK is not immune from disasters. These can range from storms and flooding, to catastrophic fires and terrorist incidents. 

Ind 9 Trickey Gray

Helen Gray from the WBTi team has co-written, with Heather Trickey, a blog on the need for the protection of infants and young children in emergency situations

 

 

 

More recently, in response to the arrival of Hurricane Ophelia in Ireland and the UK, the WBTi team has joined in setting up a social media awareness campaign on protecting infants and young children in emergencies, using memes like the one below to communicate key concepts on the Safely Fed UK Facebook page.

Safely Fed UK Power Outage

Ind 9 global

 

Gaps in policies worldwide

Yet around the world, the WBTi global report has found that planning for infants in emergencies is one of the weakest policy areas in infant feeding in many countries.

 

 

 

 

 

Global guidance and recommendations

The World Health Assembly (WHA), composed of delegations from all our countries, has recognized the importance of including planning for infants and young children in all disaster-preparedness planning. WHA Resolution 63.23 calls on all nations to incorporate the international standards outlines in the Operational Guidance on Infant Feeding in Emergencies

Ops Guidance IFE 2017

 

The newest update of the Operational Guidance has just been published by the international Infant Feeding in Emergencies Core Group, which brings together leading humanitarian organisations and experts working in this field.

 

 

 

Planning for the protection of infants in emergencies in the UK

The WBTi assessment of UK policy in 2016 found that there is no central national strategy on infant and young child feeding in emergencies, but that emergency planning is devolved to local areas.

(See Indicator 9 on UK policy on planning for infants in emergencies here ) 

Our first Anniversary Forum, to be hosted by Alison Thewliss MP, chair of the All Party Parliamentary Group on Infant Feeding and Inequalities, at the Houses of Parliament in November, will bring together emergency planners, members of Local Resilience Forums, government agencies, researchers and infant nutrition specialists to explore how protecting infants and young children can be woven into the UK emergency-preparedness system.

In December, the Lactation Consultants of Great Britain will be hosting a specialist training on infant feeding in emergencies in developed countries, led by the Safely Fed Canada team, aimed at public health officials, emergency planners, specialist health visitors working with vulnerable populations and refugees, and infant feeding leads.

Disasters can and do occur in the UK, and we need to be prepared.

Banner illustration:
Created by Michelle Pensa Branco from Safely Fed Canada for Safely Fed UK: Infant and Young Child Feeding in Emergencies Facebook page 

 

Helen Gray IBCLC photo

Helen Gray IBCLC is Joint Coordinator of the World Breastfeeding Trends Initiative (WBTi) UK Working Group. She is on the national committee of Lactation Consultants of Great Britain, and is also an accredited La Leche League Leader. She represents LLLGB on the UK Baby Feeding Law Group, and serves on the La Leche League International special committee on the International Code.

 

 

Happy 6 month anniversary to us!

Happy 6 month anniversary to us!

WBTI reports
The first WBTi assessment of the UK was launched 6 months ago today in Parliament, hosted by Alison Thewliss MP, chair of the Infant Feeding and Inequalities All Party Parliamentary Group.

Huge thanks to Alison and the APPG, and to all the amazing organisations in our Core Group who worked together to identify gaps in UK policy and programmes in infant feeding, and to jointly generate recommendations for Action!

The Core Group of organisations and agencies involved in various aspects of infant and maternal health and infant feeding identified gaps in UK policy and programmes and generated joint recommendations for action.

 wbti-core-group-2015.png

WBTi Core Group:
Association of Breastfeeding Mothers (ABM)
Baby Feeding Law Group (BFLG)
Baby Milk Action
Best Beginnings
Breastfeeding Network (BfN)
Child and Maternal Health Observatory (CHIMAT) Department of Health
First Steps Nutrition
Institute of Health Visiting (iHV)
Lactation Consultants of Great Britain (LCGB)
La Leche League GB (LLLGB)
Maternity Action
Northern Ireland infant feeding lead
NCT
National Infant Feeding Network (NIFN)
Public Health England (PHE)
Scotland Maternal and Infant Nutrition Coordinator Start4Life
Unicef UK Baby Friendly Initiative

 

WBTi Steering Group and main authors:
WBTI steering group

From left to right:
Ayala Ochert, Alison Spiro, Helen Gray, Clare Meynell, Patricia Wise, Liz McGregor