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.

‘Tigers’ is coming!

‘Tigers’ is coming!

The gripping film ‘Tigers‘ is based on the true story of former Nestle salesman Syed Aamir Raza, who took on the baby milk industry, with the help of IBFAN, when he realised the tragic impact of his work.

The World Breastfeeding Trends Initiative (WBTi) UK team has arranged a screening of ‘Tigers’ at the Lexi cinema in Kensal Rise on Wednesday 5thDecember at 10.45am, to mark the 2nd anniversary of the WBTi report on the UK.

The Lexi is situated in Kensal Rise, north-west London, and is the UK’s first social enterprise independent boutique digital cinema, donating its profits to charity.

Lexi cinema

Following the 90 minute screening, there will be an opportunity to discuss issues raised by the film, and a discussion on issues in breastfeeding support in the UK raised by the WBTi report.

The WBTi project brought together nineteen of the main organisations and government agencies working in maternal and infant health, to assess the state of infant feeding policies and programmes the UK, and to collaborate to produce recommendations for action – 46 in all!!

The global WBTi project is an initiative started by IBFAN (The International Baby Food Action Network). In Pakistan, IBFAN supported Syed Aamir Raza to take on the might of Nestle, while in the UK, IBFAN is known to all of us as Baby Milk Action.
Proceeds from the film support IBFAN’s work.

One innovation in the UK report was our inclusion of mothers’ perspectives, and the incredible way that breastfeeding mothers have supported the whole project, through social media, volunteering, and bringing the report and recommendations to the attention of their local commissioners and MPs. The WBTi Steering Group is keen to acknowledge the crucial role of mothers, and we are delighted to dedicate this anniversary event to all of you!

Economic systems, however, do not acknowledge the contribution of unpaid work like caring for a baby. The irony is, that if breastfeeding rates rise and formula sales go down, GDP is lessened. Similarly, an increase in formula sales increases GDP!  Australian economist Julie Smith has highlighted this, for example in her article Breastfeeding and the Measurement of Economic Progress.

Julie’s work has also informed the Australian WBTi report, which used a gender budgeting approach.

Returning to the Tigers screening, the cinema only has seating for 75, so if you’d like to come, we encourage you to purchase your ticket (£10) very soon.

 

Banner photo courtesy of Baby Milk Action

Cinema photo courtesy of the Lexi cinema

 

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.

Breastfeeding: Foundation of Life

Breastfeeding: Foundation of Life

World Breastfeeding Week 2018 (link) ends today. Kate’s six daily blogs for it have helped to explore in a UK context the key themes of nutrition, food security and poverty reduction which underpin the strapline Breastfeeding: Foundation of Life.

Nutrition

Breastmilk is uniquely tailored to the needs of the baby receiving it. The most critical time for epigenetic changes is from in utero to age 3 years so gene expression may be significantly affected by the nutrition the baby receives. Early nutrition also influences the development of the gut microbiome; vaginal birth, particularly at home, skin-to-skin contact and breastmilk help to seed the infant’s gut microbiome from the mother’s microbiota, and oligosaccharides in breastmilk are food for beneficial bacterial species. A healthy gut microbiome helps to programme the immune system and lessen the chances of the person developing non-communicable diseases (NCDs).

Food security

Breastfeeding ensures food security, including in times of crisis, as even malnourished mothers can breastfeed and the baby thrive. There is no reliance on external supplies, equipment or hygienic conditions for preparation. Breastmilk is the most locally produced food possible.

Poverty reduction

Breastfeeding is a low-cost way of feeding babies. The mother may be hungrier and eat more so then there is an additional cost, but a minimal one compared to formula-feeding a baby, which in turn can increase poverty as there is less income available for the rest of the family.

In addition, and Kate has given details, not breastfeeding increases the health risks of both babies and mothers. This has consequences for society as it leads to increased healthcare costs.

WBW Objectives

The 4 objectives are to:

Inform people about the links between good nutrition, food security, poverty reduction and breastfeeding.

Kate described how she has incorporated it in her Year 7 teaching about reproduction and led a school assembly on it. Despite others’ misgivings, the reality was that the boys responded maturely.

Anchor breastfeeding as the foundation for life.

Engage with individuals and organisations for greater impact.

For example, in April 2018, the World Breastfeeding Trends Initiative (WBTi) UK Steering Group organised a conference with the iHV (Institute of Health Visiting) at the Royal Society for Public Health; the conference summary has just been published.

Galvanise action to advance breastfeeding as part of good nutrition, food security and poverty reduction.

This needs education about breastfeeding in schools, workplaces, health professional training, parliaments……, with practical actions to improve support for mothers wherever they are and to encourage people to be supportive. The WBTi UK report in 2016 identified specific gaps, and recommendations to address those gaps.

 

Feature photo credit: Adobe Stock

 

30. Photo for WBTi MAINN presentation

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

Breastfeeding and the impact on society

Breastfeeding and the impact on society

I recently had a very interesting conversation with a friend who breastfed in America. Her initial observations of breastfeeding in the UK is that it is a lot more open and society a lot more accepting of mothers doing it. It’s interesting because, despite our generous maternity leave in comparison to The States and the legal status that a mum can breastfeed everywhere (not in place in every state in the U.S.A!), our rates remain some of the lowest in the world. So what is it? There are many articles and books discussing the matter. But more often than not, the “blame” lies with society. Society’s perception that bottle feeding is the normal. Why does every baby doll kit come with a bottle?! Why are we instilling in our children from a young age what is not biologically normal? Not that we should be looking for who or what to blame. We should be looking for solutions to ensure that the parents of our children of the future world are able to make informed decisions about how to feed their child. There are several places where we should be focussing. For example with our government, ensuring that we follow the World Health Assembly International Code (WHO 1981) and subsequent resolutions.

An area of great interest to me is ensuring that the children of our current generation are fully informed and educated on the matter. Incorporating this into the national curriculum would be amazing. But until that time, I can take heart by teaching it in the year 7 reproduction topic that I teach. I can teach the whole school by doing an assembly on it. Which in fact was what I did with two of my esteemed colleagues, who are equally passionate about breastfeeding and supporting mothers. When I tell friends and family I did an assembly on breastfeeding, they were amazed and in awe of the “brave” activity I did. Brave because I teach in an all boys’ school. But why brave? Breastfeeding isn’t just a female topic. It isn’t just a mother topic. It is a whole society topic. The whole of society should be educated and care about it. Interestingly, the management at the school supported the idea that this was indeed a “very brave” things to do. In actual fact, the boys received the information very maturely and it led to some great conversations and learning around the topic.

If we could improve society’s perceptions of breastfeeding and improve our breastfeeding rates, what impact would this have on society? As we’ve seen in these WBW blogs, one of the key benefits of breastfeeding is a reduction in illness in both mother and baby. Also of importance is the economics of breastfeeding based on these improved health outcomes. They are quite eye-opening. A 2012 report commissioned by Unicef UK showed that investment to increase and sustain breastfeeding rates will provide a rapid financial return on investment (Unicef 2012).

Kate Butler is a Secondary School Biology teacher by day and mother to two boys (aged 2 and 4) day and night. She trained as a Kate Butlerbreastfeeding peer supporter in 2013 and since then has set up local peer support meetings in her local area and joined the committee of West Herts Breastfeeders to support with fundraising and event management. West Herts Breastfeeders is a community based mum to mum peer support group that supports breastfeeding families with their breastfeeding journeys in the community and within West Hertfordshire Hospitals NHS Trust.

References

UNICEF 2012 [ONLINE] Available at: https://www.unicef.org.uk/wp-content/uploads/sites/2/2012/11/Preventing_disease_saving_resources.pdf [Accessed 26/07/2018]

WHO 1981 [ONLINE] Available at: http://www.who.int/nutrition/publications/code_english.pdf [Accessed 26/07/18]

Breastfeeding and the impact on mothers

Breastfeeding and the impact on mothers

End of the breastfeeding shaming: Midwives ordered not to judge new mothers who choose to bottle feed” (Daily Mail June 2018). Wow, that’s one way for the Daily Mail to have a grabbing headline and epitomise what is so wrong with society’s view on breastfeeding. So basically, if new mothers choose to bottle feed, they will be judged by their midwives. They will feel guilty. I think I’m pretty confident in knowing that as healthcare professionals, midwives would be some of the least judgemental of them all? They are faced with parents making all sorts of decisions day in and day out. Professional, medical judgement must be made, but not judgement to lead to new mums feeling guilty. I was absolutely shocked by this news headline. It is the midwives’ role, always has been, to support a mother, a family, through the decisions they make. If a mother chooses to breastfeed, she should be supported. If a mother chooses to formula feed, she should be supported.

What is happening a lot for new mums is that the support to breastfeed is not there. Midwives are stretched. They don’t have the time. Women may also find that their partner, family and friends do not know how to support them. Therefore many new mums are forced into formula feeding due to lack of support, not because they wanted to. This can have deep psychological consequences due to their own preconceptions of motherhood and their idealistic expectations of what it should be like (Borra 2015). Inevitably, these circumstances may lead some women to develop postnatal depression. This is sad. A sad state that our society has put them in.

Fundamentally, breastfeeding has huge benefits for mums. Those who do not breastfeed have been shown to be at higher risk of breast and ovarian cancer, and type 2 diabetes. There is an increased risk of postpartum depression with shorter duration of breastfeeding (Chowdhury 2015) and Borra (2015) highlights the complexity of the association with postnatal depression. It’s often an urban myth that breastfed children don’t sleep as well as formula-fed children and therefore breastfeeding mums are exhausted, which could contribute to postpartum depression. Research shows that formula-fed babies sleep deeper and for longer bouts earlier than breastfed babies, although the total amount of sleep is the same (ISIS 2015). In fact, many breastfeeding mums get more sleep as to settle a waking baby can often be quicker with a breastfeed than having to make up a bottle.

 

Feature photo credit: Sally Etheridge, Leicester Mammas CIC

 

Kate Butler is a Secondary School Biology teacher by day and mother to two boys (aged 2 and 4) day and night. She trained as a Kate Butlerbreastfeeding peer supporter in 2013 and since then has set up local peer support meetings in her local area and joined the committee of West Herts Breastfeeders to support with fundraising and event management. West Herts Breastfeeders is a community based mum to mum peer support group that supports breastfeeding families with their breastfeeding journeys in the community and within West Hertfordshire Hospitals NHS Trust.

 

References

Borra C, Iacovou M and Sevilla A. New evidence on breastfeeding and postpartum depression: The importance of understanding women’s intentions. Maternal and Child Health Journal 2015; 19(4): 897–907.

Chowdhury R, Sinha B, Sankar MJ et al. Breastfeeding and maternal health outcomes: A systematic review and meta-analysis. Acta Paediatrica 2015; 104(Suppl. 467): 96–113.

ISIS 2015 [ONLINE] Available at: https://www.dur.ac.uk/resources/isis.online/ISIS_normal_2015.pdf [Accessed 26/07/2018]

Breastfeeding, Neurodevelopment and the Microbiome

Breastfeeding, Neurodevelopment and the Microbiome

Non-communicable diseases (NCDs) are currently responsible for 70% of deaths worldwide and include conditions such as cardiovascular disease, cancers, respiratory diseases and diabetes (West 2015). The gut microbiome can be described as the healthy intestinal flora (bacteria) and there is a growing amount of evidence that it can protect infants from developing these NCDs and can influence epigenetic changes (Rollins 2016). The healthy gut flora is largely determined in infancy, with vaginal homebirth and breastfeeding being the biggest contributors (Penders 2006). Therefore, by breastfeeding, it is highly possible that we might be able to reduce the incidence of these NCDs, reduce the suffering from them, on the individuals affected, their friends and family. Not forgetting the economic impact due to time off work which leads to further pressure and strain on families to try and meet the rising cost of living.

The microbiome has also been linked with neurodevelopment. Studies in animals have shown changes in emotional responses and the biochemistry of the brain when changes have been made to the gut flora (Tillisch 2013). An additional cross-sectional study looked at the development of the brain in exclusively breastfed, combination-fed and formula-fed children. The research showed that, by age 2, babies who had been breastfed exclusively for at least three months had enhanced development in key parts of the brain compared to children who were fed formula or combination-fed. The enhanced development was found in areas of the brain that are involved with language, emotional function and cognition (Deoni 2013). Could it be that breastfeeding might play a vital role in influencing children’s neural development? With the raised profile of mental health and the rise in mental health, this is certainly an interesting area for scientists to explore further.

Fig4_MicrobirthBreastvBottle5

Feature photo credit: PB2007

Kate Butler is a Secondary School Biology teacher by day and mother to two boys (aged 2 and 4) day and night. She trained as a Kate Butlerbreastfeeding peer supporter in 2013 and since then has set up local peer support meetings in her local area and joined the committee of West Herts Breastfeeders to support with fundraising and event management. West Herts Breastfeeders is a community based mum to mum peer support group that supports breastfeeding families with their breastfeeding journeys in the community and within West Hertfordshire Hospitals NHS Trust.

 

References

Deoni S.C.L., Dean D.C., Piryatinsky I., O’Muircheartaigh J., Waskiewicz N., Lehman K. Han M., Dirks H. Breastfeeding and early white matter development: A cross-sectional study NeuroImage 2013, 82, 77-86.

Penders J, Thijs C, Vink C, et al. Factors influencing the composition of the intestinal microbiota in early infancy. Pediatrics 2006; 118: 511 –21

Rollins N, Bhandari N, Hajeebhoy N et al. Why invest, and what it will take to improve breastfeeding practices? The Lancet 2016; 387(10017): 491–504

Tillisch K, Labus J, Kilpatrick L, et al. Consumption of fermented milk product with probiotic modulates brain activity. Gastroenterology 2013; 144: 1394–401.

West C, Renz H, Jenmalm MC et al. The gut microbiota and inflammatory noncommunicable diseases: Associations and potentials for gut microbiota therapies. Journal of Allergy and Clinical Immunology 2015; 135(1): 3–13.