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.

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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.

A winner! Working together to support families

A winner!  Working together to support families

If you attended the 2015 Unicef UK Baby Friendly conference you may have noticed, or taken part, in the informal World Breastfeeding Trends Initiative (WBTi) competition to guess the final assessment score. Sue Ashfield is the winner as her estimate was closest to the actual score of 50.5 out of 100 for Indicators 1-10.

The score is a measure of how the UK is performing against the implementation of key policies and programmes to support mothers who want to breastfeed and the healthcare professionals who help them.

Sue is the lead and Specialist Health Visitor (Infant Nutrition) of First Community Health and Care in East Surrey. Sue is a winner in a much bigger way than the WBTi competition because her community team was reaccredited by Baby Friendly earlier this year and they also supported 10 local children centres in achieving full BFI accreditation in one year. The formal presentation of the award was on March 14th. Sue pays tribute to the hard work of her colleagues for the achievement but it also reflects her commitment and leadership.  Read more here.

Her team is a brilliant example of what the WBTi UK report recommends for Indicator 6 (community-based support). There is close, integrated working between 0-19 public health team, breastfeeding counsellors, peer supporters and children centres at the three Baby Cafes, which have been runnning for 10 years.

Practitioners from the 0-19 team work at the Baby Cafes on a rota basis, alongside the breastfeeding counsellor. When they see mothers at home or at drop-in clinics they encourage them to attend the Baby Cafes for social support or more specialised support or just to chat to one of the peer supporters. The breastfeeding counsellors at the Baby Cafes have now trained over 200 peer supporters and this has increased the breastfeeding knowledge and skills within the local community.

Winner blog
Credit: Eleanor Stock

The photo above shows Sue holding the Baby Friendly Initiative (BFI) accreditation plaque along with some members of the 0-19 team, some senior managers and their BFI Guardian. Since April, all three community services in Surrey have come together as Children and Family Health Surrey to deliver children’s services.

Sue comments that she found particularly useful the information in the WBTi report about interventions and investment offered in the past and also Report Cards and the summary gaps and recommendations. She will use the findings in the report to inform local commissioners and disseminate information to staff and other stakeholders.

An integrated service like this is needed in all areas, yet in so many places services are being cut, particularly peer support programmes and breastfeeding support drop-ins.

Many congratulations Sue.

 

Cover photo credit: Paul Carter

PW Photo for WBTi MAINN presentation

 

Patricia Wise is an NCT breastfeeding counsellor and a member of the WBTi Steering Group

Building Loving Relationships – Indicator 2: The Baby Friendly Initiative

valentine

Will you be my Valentine? Love matters to all of us.

There will be millions of Valentine celebrations taking place all over the nation on 14 February. Hearts, red roses, chocolates, gifts, expensive treats and marriage proposals will be exchanged to signal love on that day.

But… babies are born every day. People embrace each other every day. Loving relationships begin every day! Lovers kiss every day and babies are universally loved.

Affection and love shape our brains from that first kiss on day one and continually along our life course. They create that extraordinary mother and baby bond, stimulate social interactions and enable long-lasting friendships. Early loving relationships are nurtured and supported by our families, friends, health professionals and wider society. Being held closely, and responded to sensitively, by those who love you more than anyone else, has far-reaching effects on long-term emotional security and health.

The neuroscience evidence behind this is getting stronger every year. Sue Gerhardt explained that in her book Why Love Matters: How Affection Shapes a Baby’s Brain in 2004. Margot Sunderland explained the impact of this knowledge for parenting in 2006, in What Every Parent Needs to Know: The incredible effects of love, nurture and play on your child’s development.

Humans are very adaptable and babies respond to how they are treated, feeling secure and appreciated if they feel loved. Francesca Entwistle explains the importance of helping the baby develop secure attachment in the 2013 Evidence and rationale for the Unicef UK Baby Friendly Initiative standards.

The Unicef UK Baby Friendly Initiative programme has been universal in changing attitudes and encouraging best practice over the last 20 years in the UK through robust accreditation. It delivers the minimum basic standards required to support new parents – no matter how they feed their babies. It aims to create the best environment for the start of every baby’s life but is not yet mandatory for all maternity facilities in England and Wales (see WBTi UK 2016 report – Part 1, Indicator 2).

The question is why isn’t it mandatory as recommended by NICE (the National Institute for Health and Care Excellence) 11 years ago? The guidance states: “All maternity care providers (whether working in hospital or in primary care) should implement an externally evaluated, structured programme that encourages breastfeeding, using the Baby Friendly Initiative as a minimum standard.”

The governments of Scotland and Northern Ireland have a funded national strategy with a coordinator supporting all maternal and infant health professionals, and 100% of maternity units in Scotland and Northern Ireland are accredited, with community facilities aiming to achieve the same.

This cascade of national to local support aims to ensure all parents receive the best possible information, free from the undermining effects of commercial persuasion, with practical support to be enabled to make healthy decisions for themselves, which helps fulfil the government’s health message.

Families would benefit if England and Wales followed the best practice example of their neighbours.

What does Baby Friendly care mean for parents? Relevant information from pregnancy onwards, skin-to-skin contact immediately after birth as standard practice, and practical help with learning how to feed your baby. For more details, see You can expect the following standards of care from a Baby Friendly hospital. If all expectant parents knew about the standards, they could help press for them to be implemented universally.

The WBTi UK report points out gaps and provides recommendations to overcome the many barriers that women face in their daily lives, journeying from pregnancy through birth, the postnatal months, back to work and beyond, living in their own communities. See Part 1, Indicator 2 of the report for more information, with further details in Part 2.

Implementing the WBTi recommendations would contribute to the provision of the optimal conditions all parents need to begin raising their child in a loving and supportive society.

 

References

  1. Gerhardt S (2004) Why Love Matters: How Affection Shapes a Baby’s Brain E.Sussex: Brunner-Routledge
  2. Sunderland M (2016) What Every Parent Needs to Know London: Dorling Kindersley
  3. Entwistle F (2013) Evidence and rationale for the Unicef UK Baby Friendly Initiative standards
  4. WBTi UK (2016) World Breastfeeding Trends Initiative UK Report 2016
  5. NICE (2006) Postnatal care up to 8 weeks after birth
  6. Unicef UK BFI Support for Parents 

More on Indicator 2 – Baby Friendly Care and Baby-Friendly Hospital Initiative

 

A baby is born and placed on his mother’s chest. His newborn reflexes kick in and he starts to crawl to her breast, calm and alert. This skin-to-skin contact triggers a surge in oxytocin – the so-called “mothering hormone” – and she responds by instinctively helping him to the breast. He latches on, and her milk flows.

breast crawl

When breastfeeding begins in this uninterrupted way, soon after birth, research shows that babies are more likely to breastfeed well, and mothers tend to continue to breastfeeding for longer.

Now compare this to the typical birth scenario, repeated in so many maternity hospitals:

A baby is born, and her cord is cut. The midwife announces “It’s a girl!” and then wipes the baby clean and wraps her up. Then she passes her to her mother. Then the baby is passed to her father. After a few minutes, the midwife unwraps the screaming baby and puts her on the scales and gives her a vitamin K injection. The baby is dressed and returned to her mother.

It was the recognition of this importance of this first hour that led to the development of the Ten Steps to Successful Breastfeeding – a set of guidelines that became the cornerstone of the Baby Friendly Hospital Initiative, which began in 1992.

The ten steps encompass the practices that are needed to support a “breastfeeding culture” in hospitals. They are:

  1. Have a written breastfeeding policy that is routinely communicated to all health care staff.
  2. Train all health care staff in skills necessary to implement this policy.
  3. Inform all pregnant women about the benefits and management of breastfeeding.
  4. Help mothers initiate breastfeeding within half an hour of birth.
  5. Show mothers how to breastfeed, and how to maintain lactation even if they should be separated from their infants.
  6. Give newborn infants no food or drink other than breast milk, unless medically indicated.
  7. Practise rooming-in – that is, allow mothers and infants to remain together – 24 hours a day.
  8. Encourage breastfeeding on demand.
  9. Give no artificial teats or pacifiers (also called dummies or soothers) to breastfeeding infants.
  10. Foster the establishment of breastfeeding support groups and refer mothers to them on discharge from the hospital or clinic.

In order to call itself “Baby Friendly” a hospital or institution must also adhere to the WHO International Code of Marketing of Breast-milk Substitutes (more on this in the next blog on Indicator 3).

There is clear evidence for better outcomes for babies born in Baby Friendly hospitals – for example, a study in Scotland found that these babies are 28 percent more likely to be exclusively breastfed at 7 days old.

The meaning of Baby Friendly has also evolved over time, and in recent years it has moved beyond the ten steps. In the UK, as well as protecting breastfeeding, the Baby Friendly approach now helps mothers to begin a nurturing relationship with their baby – and this protection applies to all babies, whether or not they are breastfed.

The Baby Friendly Initiative has also moved beyond maternity hospitals. In the UK, it is now possible for university courses, health visitors, children’s centres, and neonatal units to become Baby Friendly accredited.

The World Breastfeeding Trends initiative (WBTi) assessment scores each country out of 5 based on how many Baby Friendly hospitals it has. It needs have more than 89 percent of its hospitals and maternity units accredited to gain the top rating.

The assessment also looks at the quality of the Baby Friendly programme – how comprehensive the training is, whether it monitors hospitals adequately, whether mothers’ experiences are taken into account – for another possible score of 5.

How do you think your local services would score?