Fiona Godlee: Recent advances in clinical medicine, public health, and health policy. Royal College of Physicians and London School of Economics. Athens 20-22 September
4 Oct, 07 | by Fiona Godlee
Back in Athens. Much cooler than a month ago and the fires on the Peleponese are out. This meeting, arranged by Ian Gilmore and George Kitas of the Royal College of Physicians and Elias Mossialos, director of LSE Health, has an ambitious inter-professional scope but a smallish group of delegates, more than half from the UK. I assume they had hoped to attract more from Greece and neighbouring countries. Still, the mix of disciplines prompted good debate, especially on the yawning gap between academics and policy makers and how to bridge it.
We heard, among a wide range of other things, that the three biggest causes of preventable premature death in Europe are smoking, alcohol and hypertension. Prevalence of smoking is still increasing in some European countries, said John Britton from Nottingham University, and when prices fall consumption increases. We need a hike in prices and a ban on sports sponsorship, he said. Nicotine replacement isn’t working because the medicinal nicotine products are all pretty hopeless: they don’t mimic the cigarette nicotine surge and are sold like medicines so can’t possibly compete with heavily marketed and ubiquitously available cigarettes. He proposed a harm reduction approach using oral tobacco (snus) which has substantially reduced the prevalence of smoking in Swedish men.
The picture for alcohol is remarkably similar, said Ian Gilmore. As with cigarettes, falling prices mean more alcohol is drunk and at a younger age. Cultural patterns of drinking are crucial to any policy intervention. People in the south of Europe tipple their alcohol with food. In the north, especially the UK, they binge drink without food. Increasing the legal drinking age is not the answer he said. Instead we need higher prices, a ban on advertising, and reduced access to alcohol.
Lack of integration between government departments is hampering our response to the obesity epidemic, said Peter Kopelman, dean of the faculty of health at the University of East Anglia. But there was encouraging news from the wonderfully named Pat the Cope Gallagher, Ireland’s new Minister for Health Promotion. Ireland has achieved what England has not – intersectoral collaboration across all necessary government departments to tackle the wider determinants of disease.
I sat with Peter Davis and Rod Griffiths at the welcome dinner near the Acropolis. Peter Davis is head of the Liverpool Medical Institution, which sounds like a thriving place. He’s invited Germaine Greer along in December to talk about what books she’d like her doctor to have read. Perhaps we could get her to write this up for Christmas in the BMJ.
Rod Griffiths has just finished being president of the UK’s Faculty of Public Health and we got talking about fluoride. Only a fool would enter the debate on water fluoridation, he said. So I told him the BMJ was about to do just that by publishing an article reviewing the evidence and the ethical issues about adding fluoride to water supplies (6 October issue). His experience as regional director for public health for the West Midlands, which has fluoridated water, has convinced him that it reduces social inequalities, giving poor kids rich kids’teeth with no evidence of harm. By the end of the evening I had convinced him, though clearly against his better judgement, to write something for us on this.
The next morning we delegates were all agreed that doctors and academics are rubbish at making their case to government and lobbying for change. Josip Figueras, director of the European Observatory on Health Systems and Policies, gave his explanation for the gap between academics and policy makers and some thoughts on how it can be bridged. The average term of a government health minister is eight months, so they need quick results. Academics work in much slower time spans and the incentive system is fixed on publishing in academic journals rather than writing policy documents and successfully lobbying ministers. Knowledge brokers are one answer, and the Canadians are doing good work on gathering the evidence on successful evidence transfer. But Figueras has come to an interesting conclusion about the role of evidence. It’s not by being transferred that the evidence makes the difference, it’s by providing a neutral platform for discussion between disparate parties.
Competing interest: As a speaker, my travel and accommodation were paid for by the conference organisers. The conference was supported by an educational grant from Pfizer.