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fS Sta+o ft +e Guesrns ey = BOARD OF ws) HEALTH eCrARrYA sis se) WORKING TOWARDS A BETTER HEALTHIER WAY OF LIFE 98th ANNUAL MOH REPORT and THIRD ANNUAL REPORT of the DIRECTOR OF PUBLIC HEALTH Special Supplement: “The Impact of Alcohol on Health in Guernsey” REPORT FOR THE YEAR 1996/97 STATES OF GUERNSEY BOARD OF HEALTH Objectives To maintain and improve the health of the people of Guernsey and Alderney as cost effectively as possible by: Identifying health needs - now and in the future. Planning the future provision of health services to meet these needs. Ensuring that the quality of health services provided is high and standards are maintained through careful monitoring. Ensuring that only appropriate and effective care or treatment is given, by monitoring the outcome of such interventions. Informing people on health matters, promoting a healthy lifestyle and environment. Checking that all health services provided are as cost-efficient as possible. Promoting managerial and professional excellence within health services. Recruiting, training and developing sufficient health care staff to achieve these objectives. BOARD OF HEALTH MEMBERS 1996 President: Conseiller Mrs S M Plant Vice President: Deputy B Russell Senior Member: Mr G V F Birch Other Members: Deputy O D Le Tissier Deputy Mrs J Beaugeard Deputy H R Allen Deputy M Barrett INTRODUCTORY LETTER TO THE BOARD OF HEALTH October 1997 The President States of Guernsey Board of Health Madam President, Members of the Board I have pleasure in submitting the 98th Annual Report of the Medical Officer of Health for Guernsey for 1996/1997. ra I am, Madam Your Obedient Servant Dr David Jeffs MEDICAL OFFICER OF HEALTH Director of Public Health CONTENTS CONTENTS Board of Health Members 1996 Board of Health Objectives Medical Officer of Health Introductory Letter Highlights from this Report “The Health of the Islands’”’ 1996/97 Introduction Lifestyle Related Diseases ® cigarette/tobacco related illness @ alcohol and health @ illicit and prescribed drugs - the need for a drugs strategy @ prescribed drugs - The ““Medidump” - Kings Fund Review @® sexual health Health and the Environment @® BSE and CJD @ EF Coli 0157 @ Ongoing Environmental and Energy problems - Liquid and Solid Waste Management - Traffic congestion - Housing and Energy problems The “‘Greying of Guernsey”’ @ The Demographic Time bomb - is it real? @ Need for a Cancer Strategy @ Osteoporosis Staff Health and Safety The Public Health Importance of ‘‘Risk”’ @ Risk and Public Health @ “Life is a risky business....... @ The Language of Risk @ Confusing “Hazard” and “Risk” @ Perception and Acceptability of Risk @ Risk Management in a Health Setting @ A Model for Risk Communication and Management @ Risk - Conclusions, References and Further Reading Sa Environmental Health 3 Introduction & Complaints/ Requests for Advice/ Enquiries @ Food Safety and Infection Control - Food Complaints - Food Surrender - Food Education - Food poisoning 8 Control of the Physical Environment - Water Sampling - Rodent and Pest control - Housing - Air Quality Monitoring 4. Health Promotion Introduction Infection Smoking Chronic Heart Disease Cancer Alcohol and Drugs Sexual Health Family Health Accident Prevention Mental Health Health Education for Schools and Young People Training Liaison Conclusion = Communicable Disease Control @ Communicable Diseases @ Infection Control @ Sexual Health @ Infection Control Committee 6. Occupational Health and Safety ® Occupational Health @ Fire Health and Safety @ Health & Safety Working Group De Guernsey and Alderney - Vital Statistics 1996 8. Staff Providing Public Health Services 1996 HIGHLIGHTS FROM THIS REPORT HIGHLIGHTS FROM THIS REPORT Once again it is most gratifying to be able to report that for the third consecutive year “the health of Guernsey people, as measured by traditional indices, appears excellent’ . Notifications of infectious diseases are at an all-time low, and with the exception of “food poisoning’’, are no longer a significant cause of morbidity on the island. Life expectancy is high, and deaths from most major causes continue to decline. As the traditional causes of morbidity and mortality have declined, the so-called “diseases of affluence’? have become of greater importance. Epidemiological studies suggest that personal exposure to known “risk factors” increases the likelihood of developing such diseases. Known risk factors include smoking, excessive alcohol consumption, unhealthy diet and illicit and prescribed drug misuse. The dual approach of promoting “informed choice” for the individual, whilst trying to ensure “healthy public policy” for the community underpins our public health strategy to reduce the impact and consequences of “lifestyle-related diseases” on the health of the populations of Guernsey and Alderney. Smoking-related diseases can be shown to be a major cause of preventable ill health and premature mortality. They are responsible for an estimated 110-130 deaths annually, in Guernsey - without doubt the largest single cause of preventable deaths in the Islands. Because most regular smokers have become addicted before early adulthood, the thrust of a rational smoking policy must be to make smoking less acceptable, less accessible, and less affordable to young people. A package of measures designed to achieve this has been progressively implemented since the States ““Tobacco Debate” in July 1920, Alcohol, and the trade in alcohol have contributed to the prosperity in Guernsey and have been the central influence on the social history of the Island for at least three hundred years. Even today, tourism and tourism infrastructure (both of which are strongly alcohol-based) are important sources of employment and revenue. However, Guernsey must be described as a “wet culture”. Annual levels of consumption at around 11 litres Pure Alcohol Equivalent (PAE) per capita are at the upper end of alcohol consumption in Western Europe, and only a little below France. The Guernsey “Alcohol and Young Adults” Survey suggests that many young adults of both sexes are already drinking at a level likely to damage their health. The “Population Theory” of alcohol consumption suggests that the extent of alcohol-related harm in a community will be proportional to the average per capita alcohol consumption. A greater benefit will derive to that community from moderating overall alcohol consumption than merely concentrating on a “High Risk” strategy to reduce alcohol related damage amongst the heaviest drinking section of the population. Not all influences on population drinking levels are under Guernsey’s control. However, Guernsey is more fortunate than most communities in having many of the keys to effective action already in its possession. If the community accepts that alcohol consumption at present levels will have an adverse impact on many aspects of community life, then it will require both political will and popular support to bring about the necessary change. Along with tobacco and alcohol, Guernsey must also be seen to have the potential for a greater “illicit drugs” problem. To achieve the best mix of services to address this will require inter-departmental working to develop an appropriate ““Drugs Strategy”. Such a process is already being addressed. Prescribed drugs also have the potential for inappropriate use. This is a further area which must be tackled by joint action between the Board of Health, Guernsey Social Security Authority and prescribing Medical Practitioners. The value of collaborative inter-departmental working was also shown by successful efforts at co-ordinating approaches to control of BSE, and possible associated risks to human health through Cruzfeldt-Jacob Disease. This approach was also extended to ensure successful implementation of the Pennington Enquiry recommendations on E Coli O157 in Guernsey. The so-called “demographic time-bomb’’, brought about by an ageing populating is a cause of great public concern. The results of the 1996 Census shows that Guernsey has a lower percentage of population over 65 years than the UK, and many other European countries. The “demographic time-bomb” in Guernsey may be said to have a fairly long fuse. Nonetheless, there are issues which must be addressed now in order to prepare adequately for the eventual “greying of Guernsey”. These include the development of a cancer strategy, and a rational approach to the prevention and management of osteoporosis across the population. It is intended that “The Health of Older People” will form the “special theme” of the 1997/98 Annual MOH Report. An understanding of the concepts of risk, risk communication, and risk management are important to the understanding of public health in general, and also to the individual disciplines of environmental health, health promotion, communicable disease control, sexual health, and occupational health and safety. These concepts are further explored in this Report. A framework is proposed to give clearer understanding and better communication of hazards which may pose threats to the health of the people of Guernsey and Alderney, both now and in the future. INTRODUCTION Chapter I “The Health of the Islands”? 1996/97 “To maintain and improve the health of the people of Guernsey and Alderney as cost effectively as possible........ A Primary Objective - Guernsey Board of Health Introduction Welcome to the 98th Annual Medical Officer of Health (MOH) Report, and the third Report of the Director of Public Health (DPH) for Guernsey. Once again it is most gratifying to be able to report that for the third consecutive year “the health of Guernsey people, as measured by traditional health indices, appears excellent’ . Notifications of infectious diseases are at an historical all time low, and with the exception of “food poisoning” (of which more later), are no longer a significant cause of morbidity on the Island. Life expectancy is high, and deaths from most major causes continue to decline. So where now should the Board of Health be focusing its resources to best achieve their objective “to maintain and improve the health of the people of Guernsey and Alderney as cost effectively as possible.............?” Many topics of public health significance and importance are touched on in the body of this Report, and it is therefore difficult to select those particular aspects which seem to offer greater potential for personal health gain, or to provide wider benefits for the community from improvements in population health. But, if public health, at least in part, is about achieving the best health for the greatest number at the most affordable cost, then certain areas commend themselves for more-in-depth analysis. This year I have chosen to highlight the following topics which I feel to be of particular significance or importance to the health of the islands. Lifestyle Related Diseases As traditional causes of morbidity and mortality have declined, the so- called “diseases of affluence” have become of greater importance. Epidemiological studies suggest that personal exposure to known “risk factors” increases the likelihood of developing such diseases. There is thus an element of personal choice in the degree to which we choose to expose ourselves (or to avoid) known risk factors such as smoking, excessive alcohol consumption, unhealthy diets, and illicit and prescribed drug misuse. Part of the role of Public Health, shared with the other health professions and with the media must therefore be to ensure that the public is sufficiently aware of known risk factors that people can make an “informed choice” as to their degree of exposure. However, it is obviously wrong to always “blame the victim” for the development of lifestyle related diseases. It is unreasonable to expect people, especially the less affluent, to choose healthy alternatives when less healthy choices are more accessible and less expensive. Thus the complementary role of public health must be to ensure that there is “healthy public policy” at every level of government and that “‘healthy choices” become “‘easy choices,” accessible to the whole population. This dual approach of promoting “informed choice,” for the individual, whilst trying to ensure “healthy public policy” for the community underpins our public health strategy to reduce the impact and consequences of “lifestyle related diseases” on the health of the populations of Guernsey and Alderney. e Cigarette/Tobacco Related Illness A good example of this dual approach is illustrated by our progress with tobacco control during 1996/97. The Government White Paper ““The Heath Of The Nation” claimed in 1992 that “Smoking remains the largest single cause of preventative mortality in England”. All local evidence suggests that tobacco related ulness is an equal or greater problem in Guernsey, with more affordable cigarettes, a greater proportion of young people smoking, higher levels of smoking amongst those who do smoke, and higher cigarette related mortality over a five year period for both men and women when compared with their counterparts in England. Smoking related diseases can be shown to be responsible for between 110 and 130 deaths annually in Guernsey. Recognising the importance and potential benefits of reducing tobacco related illness on the islands, the Board of Health has supported and developed an integrated and co-ordinated Tobacco Strategy, culminating in a Policy Letter on ““The Impact of Advertising and Duty on Alcohol and Tobacco Consumption in Guernsey”, which was debated by the States of Deliberation in June 1996. Given the overwhelming evidence on the adverse health consequences of cigarette smoking, after a lengthy and sometimes heated debate, the States agreed to support all the Board of Health propositions, the effect of which will be to:- @ introduce a total ban on all public advertising of tobacco and tobacco products except a point of sale. Imported print media will be exempt. ® increase the size and content of pack warnings as originally proposed in the Draft Voluntary Agreement on Tobacco Advertising;