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.

‘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.

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?

 

 

 

Sustaining breastfeeding together: Partnerships for the Goals

Sustaining breastfeeding together: Partnerships for the Goals

The theme for this year’s World Breastfeeding Week  is all about the importance of building multi-level partnerships to work together to support and protect breastfeeding and achieve the UN’s Sustainable Development Goals.

The final Sustainable Development Goal, number 17, calls for cross sectoral and innovative multi-stakeholder partnerships to achieve sustainable development.

Research has shown that the most effective way to improve breastfeeding rates is to implement policies and programmes at every level, from hospital to home and community, with support available from health professionals, peer supporters, friends, families and society.

One of the main WBTI recommendations outlines how this could be led from the top in the UK:

A national sustainable Strategy Board, including representatives from all the voluntary groups, health professional organisations, and NGOs to share best practice between devolved nations coordinated by a high level funded lead specialist.

A good breastfeeding journey for a family begins with birth in a Baby Friendly accredited hospital, and continues at home, surrounded by supportive family and friends, with easy access to skilled health professionals and mother support groups in the community. Once they return to work, mothers are supported by their employers to continue to breastfeed as long as they wish. Legislation protects families from misleading marketing by the baby feeding industry, and ensures safe and high quality breastmilk substitutes are available for those babies who need them.

A strong partnership between all sectors is essential to supporting families throughout their journey. The WBTi project was centred around building a strong partnership between organisations and agencies involved in maternal and infant health in order to monitor and assess the UK’s implementation of key infant feeding policies and programmes. The decision-making Core Group was responsible for determining the gaps and recommendations for the WBTi report and its member organisations had to be free from conflict of interest with regard to funding from the formula, baby food, bottle and teat industries. Organisations covering the full spectrum of maternal and infant health were invited to participate in the wider WBTi consultation.

Together, we can build a better future for Britain’s babies.

 

The WBTi Core Group

Association of Breastfeeding Mothers   https://abm.me.uk/

Baby Feeding Law Group    www.babyfeedinglawgroup.org.uk/

Baby Milk Action www.babymilkaction.org/

Best Beginnings   www.bestbeginnings.org.uk/

Breastfeeding Network   www.breastfeedingnetwork.org.uk/

Child and Maternal Health Observatory   www.herc.ox.ac.uk/downloads/health_datasets/browse-data-sets/child-and-maternal-health-observatory-chimat

Department of Health   www.gov.uk/government/organisations/department-of-health

First Steps Nutrition   www.firststepsnutrition.org/

Institute of Health Visiting ihv.org.uk/

Lactation Consultants of Great Britain   www.lcgb.org/

La Leche League GB   www.laleche.org.uk/

Maternity Action www.maternityaction.org.uk/

Northern Ireland infant feeding lead

NCT   www.nct.org.uk/

National Infant Feeding Network www.unicef.org.uk

Public Health England  www.gov.uk/government/organisations/public-health-england

Scotland Maternal and Infant Nutrition Coordinator www.gov.scot/

Start4Life www.nhs.uk/start4life/

Unicef UK Baby Friendly Initiative www.unicef.org.uk/babyfriendly/

 

Other organisations who participated in the WBTi consultation

British Dietetic Association. https://www.bda.uk.com

Cabinet Office https://www.gov.uk/government/organisations/cabinet-office

Department of Health http://www.gov.uk

General Medical Council  http://www.gmc-uk.org

General Pharmaceutical Council   https://www.pharmacyregulation.org

Nursing and Midwifery Council   https://www. nmc.org.uk

Public Health Agency Northern Ireland www.publichealth.hscni.net/

Public Health Scotland   http://www.gov.scot/

Public Health Wales http://www.wales.nhs.uk/

Royal College of General Practitioners http://www.rcgp.org.uk

Royal College of Midwives http://www.rcm.org.uk

Royal College of Paediatrics and Child Health https://www.rcpch.ac.uk

Royal College of Obstetricians and Gynaecologists http://www.rcog.org.uk

Unite, the Union of Community Practitioners and Health Visitors Association www.unitetheunion.org/

U K Standing Conference on Specialist Community Public Health Nurse Education

 

Relevant quotes:

The Lancet Series on Breastfeeding concluded that breastfeeding is the responsibility of all of society, not just the individual woman. http://www.thelancet.com/series/breastfeeding

It takes a village to raise a child………so says the African proverb.

UK Shadow Health Minister Jon Ashworth recently said ‘Children’s health is central to improving wellbeing and economic status of a country’.

 

By Clare Meynell and Helen Gray

Joint Coordinators

WBTi UK Working Group

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