Focus Group 6
Me / What is the biggest health problem facing everyone today?FG65 / Obesity.
Me / Can I ask why? Well I will ask why.
FG65 / It would seem to me that a lot of the younger people are certainly not taking part in active sports as much as they used to do in the past and this is leading to problems both here and in America with the possibility of obesity in children as they go through life.
Me / Has anybody got any more to say on that or a different problem completely?
FG62 / I can say to a point it is a problem but not as public health. I thought public health is to put in clean sanitation, clean water, sanitation, control of infectious diseases basically.
Me / I’ll say then health problems, any health problems.
FG62 / Health problems, well obesity and sexually transmitted diseases.
FG63 / Drugs under health.
Me / Drug abuse yeah, I’ll include that in as well.
FG64 / I think the eradication of cancer, I mean that, get it out by it’s roots.
Me / OK any others?
FG61 / Childhood asthma, which usually leads to long-term asthma. I was lucky that my children haven’t got any ailment at all ?I feel very lucky with? children, but their cousins do have for various reasons, whether they’ve lived in cities or for other reasons, Inexplicable allergies that just develop and seem to be turning into long term problems.
Me / Any other problems or what I would ask is then for those propositions that have been mentioned why do you think they are so important? Is it the type of illness, the scale of the illness or…?
FG61 / Think you have to look at the causes before you look at the actual treatment, the problems themselves, lets look at what the causes are. Start from the bottom up and find out what cause is rather than treat it once its become a problem and then you won’t have the problems to deal with
FG62 / The other thing I suppose is poverty in general, because poor people are sicker than the more wealthy.
FG61 / Might be that the more wealthy might go to the doctor more often __ can’t take time off work.
FG62 / It’s lifestyle really. Something to do with that the poor people tend not to look after themselves, whether it’s out of ignorance or just because they don’t care, I don’t know.
FG64 / I find the term public health a little confusing because when I was young and it meant things like sanitation, or a public health or sanitary inspector and in this context I take it means the health of individual members of the public?
Me / Yes, for the sake of the general discussion about health issues and why you think they’re important. Different people think different things are important for different reasons. For example you mentioned cancer as a big health problem. Why do you think that’s a big problem, just numbers?
FG64 / Well I think it is manifest isn’t it? The numbers are so great, I think it kills more than…, it’s the greatest killer of all. People, the, tobacco, the last cigarette you had 30 years ago causes it now.
Me / OK that leads me on to our next question. When we think about health problems, whether the ones you’ve mentioned or others: what do you think the government should do to improve health?
FG61 / They should bring it back into schools, they should bring it back into the issues in biology and home economics, I think it is, and stuff like that. All these were covered when I was at school, a while ago, but they don’t seem to cover it in school at all now, regards nutrition and health, lifestyle, it’s not actually part of the curriculum, it’s sort of covered fleetingly. Oh well we’ve done that, and then that’s it, it’s left, it’s not ongoing development of the individual as they go through school, taking them through the stages and the other learning that they should have in order to cope with life outside. There’s a lot of things that aren’t covered in schools.
FG62 / The other thing they could do is ban smoking in all public places. __+ I’m very anti-authoritarian, as much as people can do what they want, but I think that smoking is something that should be done by consenting adults in private. They can kill themselves if they want, but in a public places I think it ought to be banned.
FG61 / I think for the Government that’s why the income costs, what they get from the income and what it’s costing them at the moment in healthcare. Because they are going to have an ongoing problem to, if people start dramatically ?chopping up? smoking, two of my children smoke and I keep telling them not to. ?Course? I told them about the extra additives that have been put into cigarettes to make them even more addictive than they were thirty years ago. But it would be very difficult for the government to, if they were to lose 50% smokers they’ve lost that income and they’ve still got the people to treat now without having a wedge of money to…
FG63 / Hypocrisy is the word.
FG61 / If they don’t all give up smoking all at once, they should do it gradually over the next thirty/forty years.
FG63 / They want it both ways.
FG62 / I don’t know, you see all sorts of different figures, but I must admit that a lot of the health care budget is spent on the treatment of smoking-related diseases. If we didn’t have any of these – it’s a none answer really, because people will always want more health care but if you’re doing things, as accountants do, saying “we get this amount of income from smoking, it costs this much to treat smoke related diseases”, they probably equal up to an extent. Am I right?
Me / I wouldn’t like to say, I don’t know, I really don’t know. Any other ideas about how the government should help improve the health of the public?
FG64 / I think it has become too much of a political football, the National Health Service in particular and the government should take a much longer view of things than four years. I wonder whether the present system is as good as the old when you have national headquarters, regional headquarters, district headquarters and then down to the bottom in a nice, tidy system. I should think financing it would have been easier then than it is now. You hear of primary care health trusts virtually going bankrupt, should not be so.
Me / Any other ways the government can tackle health problems?
FG65 / Yes, more control over food and food additives in particular, __
Me / So for processed foods?
FG65 / Yes. We’ve got to buy, we need food, but it’s imperative that it’s as wholesome and as unadulterated as it can be.
Me / Does that mean regulation?
FG65 / Of the food industry? Yes more regulation, tighter regulation, better regulation, whatever you wish to call it.
Me / Any other ideas?
FG65 / I think the water is OK, something you need, you have to have.
FG62 / Fluoridate the water to stop people getting caries.
Me / Would you be happy with that?
FG / Yeah, I’m happy with that.
Me / I’ve got a couple, you’ve mentioned a couple of potential policies that could be done. I’ve got one here that I’ve prepared earlier. I will help with the potential solution, I’ll just hand them around then when I’m sat down I’ll read it out and I’d just like you to think, what do you think of this policy really?
Speed Limits policy….
FG63 / I don’t think many people would disagree with it as a figure and reading that. It’s just a case of how you’re going to apply it that’s all-important. If you’re going to go on to residential estates with lots of kids, fine, going into the middle of towns, fine. But you all know while driving round the country, I mean in Derbyshire, apply 50 miles an hour all down the A6, now there’s some areas on that, there’s no reason why it shouldn’t be 60. The County Councils are just throwing in figures, signs, there doesn’t appear to be any reason for some of them at all, maybe there trying to get rid of their March budget on signs, but as such I don’t think any sensible person could disagree with 20 miles an hour in proper residential areas.
FG65 / Would this be 24 hours a day, necessarily?
Me / I think the idea is yes.
FG61 / They have in Australia, I moved out there, have 20 mile an hour, equivalent of 20 mile an hour as it’s kilometres out there, 20 mile an hour speed limits outside schools and playground areas. Outside schools they do it at certain times and it is in term time. Outside play areas and some play areas are actually attached to schools, so they are public fields that the school uses during term-term, those are done by certain hours of the day, so in other words it would be from 8 o’clock in the morning until 8 o’clock at night, and that is the equivalent of 20 mile an hour speed limit and they have speed cameras at the beginning and at the end. And they are a huge signs, huge signs saying these are the hours it operates.
Me / So you would be happier when it is certain hours rather than just?
FG61 / Probably yes because then it makes sense because, with they’ve found it works out there because they have had it out there for quite some time, there’s markings on the road, a different colour strip that you drive across so you can’t say you haven’t seen the signs or the signs up on the street were obscured or something. There is no excuse. And because it’s across the board everywhere, the same times, then anywhere you drive in New South Wales it’s all the same. If it ‘s a school day, and it’s a school day, you know what the times are, you know what speed you should be going at. People do do it, they do slow right down, they really do. They are far better at doing it in those areas than we are, I think overall their deaths on roads, per head of population, has halved now.
FG62 / This is fairly convincing on the figures, but this doesn’t mean weight of numbers, a significant number of injuries in urban areas, if you compare us to the rest of the world. Is it really worth doing in terms of…
Me / So a sixty per cent reduction if it’s one person a year, is maybe not worth it, three hundred people a year it might be worth doing?
FG62 / Yeah, that sort of thing.
Me / I don’t know the answer I’m afraid, apologies for not giving you all the facts there. Any other comments on that, any views on that? Whether it’s a good thing, bad thing?
FG61 / Think it’s a good thing.
FG64 / It’s speed that kills. I remember learning when I was a boy the force of impact is ½ m v squared, half the mass of the car times the square of the speed thus if you had an accident at 30 miles an hour it’s 900, as opposed to 20, becomes 400, and then of course we had the demon drink.
FG62 / A point of interest on this sort of thing, somebody has had a scheme somewhere in England where they’re, can’t remember the details, but they’re mixing pedestrians and traffic and not trying to separate them and the article I saw said it seems to be working because people make eye contact and walk and drive very carefully.
FG61 / Taken away all the signs haven’t they, all the signs have been moved. All the street furniture, signs, have all been removed. Taken away pavement, __ and the whole lot, Cambridge was it.
FG62 / Thought it was somewhere like Durham, I can’t remember. It hasn’t been going for very long but it seems to be working, I think.
FG61 / Was it something to do with the confusion of road signs for drivers it said it’s overloading drivers and the pedestrians haven’t got enough room.
FG62 / I think the theory is that if you put up a speed limit, people drive at it. If you’ve got your bit of road, you can drive at 20 miles an hour, 30 miles an hour, but if you’ve got to share it with pedestrians and cyclists you take more care. And they __ find people were making eye contact and slowing down, people being altogether more courteous than otherwise.
FG? / Don’t think it will work in Bakewell.
FG / So we’ve got no reservations about that policy then? Right, we’ve got another one, same drill I’ll just hand it out. The policy which is being discussed is the fortification of food with folic acid.
Folic Acid
FG63 / What’s neural tube defects?
BL / Spina bifida is the common one and anencephaly, which is a bit similar but in the head, is the other. So it’s when the spine doesn’t close properly and so the spinal cord is exposed, so it’s sometimes fatal and sometimes not, or can lead to disability.
FG63 / How many babies are born in the United Kingdom in a year?
Me / In total?
BL / About 60 000 isn’t it, no 600,000.
FG62 / So statistically it’s not a high proportion of children born with neural tube defects anyway.
Me / No
BL / Well __ in the past because often they’d be picked up on a scan.
FG62 / To treat a whole population there must always be side effects to avoid a very small proportion, a small number.
BL / It might mask the fact that a number of people will abort foetuses with, will be picked up and then aborted. So that’s probably in addition to the number of babies born.
FG62 / And why does it say if it goes ahead the treatment of B12 deficiencies will be made more difficult?
Me / It’s a fairly technical argument which I don’t fully understand but vitamin B12 deficiency is mainly seen in the elderly and folic acid gets in the way of the screening test they do for vitamin B12 deficiency. So it means you can’t identify it as quickly and therefore the signs and symptoms are not picked up until later, therefore these problems, which is called peripheral neuropathy, this feeling of numbness, sometimes can’t be avoided. That’s the problem with it.
FG62 / But in order to make the judgement you need to know how many cases of B12 deficiency there are, it’s obviously a balance I would have said. I don’t think you can say anything, you can’t comment on this.
FG63 / Are we saying at the end of the day that in rough terms the number of spina bifida babies or others in that group will be cut by half by the addition of adding folic acid to the whole of the food chain.
Me / Give or take, yes.
FG61 / What would it be added to? What foodstuffs?
Me / Essentially it’s added to flour, so anything made with flour would have it in, although you may be able to buy non folic acid foods, so maybe organic foodstuffs, but your flour, your cornflakes.
FG61 / What else do we have in flour, because they did something in the war didn’t they where they added something to flour, for the health of the nation, so that in your daily bread you got, whatever it was they did at the time.
FG65 / I think there is one vitamin added to it already.
FG61 / I just think at what point do you stop forcing things on people, you’ve got fluoride put in the water. My first child had fluoride drops because I was told __+ fluoride drops and guess what, it was already in the water. They just put it in and they hadn’t told anybody, they hadn’t even told the dentist that they had put it in.
FG62 / The other thing about this is, you’ve got a population to be taught, you’ve got pregnant women, surely ?pregnant women? advised to take “folic acid”. Why should the rest of society have additives put in when you know who to give it to?
Me / I know the answer to that one. They reason why it’s suggested is that to get the effect of folic acid it’s got to be taken pre-conceptually, so before the baby’s conceived. Only 10% of women will do that when they’re planning a child, even if the majority are told about it and 50% of pregnancies are unplanned, so it’s impossible to take it pre-conceptually, so those are the two general reasons to do with that. Have you got an opinion about whether those are good things or bad things?
FG63 / If we’re looking at the whole thing dispassionately, 180 babies out of 600,000 - it’s not a very high priority in my view.
Me / That’s fine. Your view is quite good for me. Any other views?
FG61 / Presumably 50% of those are planned then 50% of those will not be affected because the mother will have taken folic acid to start with, so you’re only talking about 50% of the mothers anyway.
Me / May have taken it, most don’t.
FG61 / May, more likely to.
I would agree with you there, yeah.
FG65 / There’s not enough information to make the judgement because the statement “this could lead some elderly people” - some - “getting feelings of numbness” - what is that? - “in the arms and legs”. What is happening to these people? How many elderly people percentage-wise? What feelings of numbness do they get, how often does it occur, is it there all the time, etc etc? There’s a whole host of problems there. Can that be quantified at all?
Me / Not as accurately as maybe it should. I couldn’t tell you off the top of my head. The evidence for that is not firm, because they know it will happen but they don’t know whether it can be avoided.
FG61 / In that case you shouldn’t do it. You could have people say using sharp knives and cutting themselves and having to be hospitalised. Elderly people are bound to take longer to recover from injuries. Another factor is that injuries are more likely to be of a severe nature rather than a mild trauma. If they getting numbness in their feet they could slip down steps, break a hip and I would say overall in that case it shouldn’t be done.