Our Chance, a new campaign launches

Today sees the launch of Our Chance, a behaviour change campaign to gives information and advice to reduce pregnancy risks and raises awareness of things that can go wrong in order to help mothers and their babies be healthy and safe. Meadows Communications were appointed by Best Beginnings, Sands and the Department of Health the summer to undertake the brand development for the campaign. Working at speed and with a limited budget, we provided three different creative propositions that were put to audience testing. Following feedback we refined the chosen route Our Chance. The campaign has been developed to help meet the Government’s aim to halve the number of babies and mums-to-be who died by 2030.

Becoming a dementia friend

Today I took a 96 year old cousin of my long deceased grandmother to a memory assessment. I’m her only living family, albeit a distant member. It was a challenging morning for both of us. Not only does she now have very limited mobility which makes it a huge effort getting her in and out of the car and in and out of a community hospital building, but given her increasingly poor mental health it’s distressing for her to be moved about, to meet new people and be asked questions when she doesn’t understand what is expected of her. And I too find it difficult because I feel very ill-prepared to be able to support her effectively as I know little about the condition and what best to say or do to help her. That’s why I have now signed up to become a Dementia Friend. I’ve watched the video, sent off for my pack and requested a date to attend an information session. I’ve joined over 1 million people in volunteering to become more aware and more supportive of the rapidly growing number of people in the UK with dementia. This seems to me to be a necessity for all people to ensure we can each demonstrate empathy and understanding to affected people in our communities that we could encounter any time any day. By each of us thinking and acting differently we can each help to value each individual and tackle the exclusion that dementia too often brings.

Ambitious plans for Dorset’s healthcare

Earlier this week the new Conservative government renewed their election pledge to provide an additional £8 billion of funding to the NHS and to deliver seven day a week access to GP services. Echoing the national direction of travel embodied within this pledge and also Sir Bruce Keogh’s review of urgent and emergency services are the ambitious new proposals from NHS Dorset CCG. The CCG’s Governing Body have today approved ambitious new proposals to improve the quality, safety and sustainability of health care services across Dorset. The plans include a bold vision for how to deliver greater access to GP and community services and a shift to having more care delivered closer to home and outside of acute hospitals. Acute hospital provision will change with the establishment of centres of excellence delivering the very best in emergency and planned services. Amy has been working with the CCG since October 2014 to help shape their engagement and communications work at this exciting time. She will continue to providing strategic advice up to the planned public consultation that will take place later this summer.

dorsetsvision.nhs.uk

This Girl Can

Congratulations to Sports England on the launch of the ground-breaking This Girl Can, a new national campaign that celebrates the women who are doing exercise and participating in sport no matter how they do it, how they look or even how sweaty they get.  We think this is a campaign with a great brand (and an eyebrow raising, head turning sassy video with music by Missy Elliott) that we hope will succeed in inspiring women up and down the country to wiggle and jiggle. It’s vital for us to motivate more women to participate in physical activity to help improve physical and mental health as well as connecting people with others in their community and their surrounding environment. We’re proud that our work with Ottaway Strategic Management throughout 2013 for Bury Council’s I Will If You Will has provided the valuable monitoring and evaluation means by which lessons from this pilot campaign have gone on to quickly and effectively influence the shape of the national This Girl Can. So come on girls, let’s see you get on, get in and show just how you can.

Where you live can make, and keep, you ill

The economic and financial think tank Centre Forum have produced a hugely compelling but frankly shocking atlas of mental health variation to demonstrate the differences in the mental well-being of people across England. It exposes how people’s mental health problems are likely to be both caused by, and exacerbated by social, cultural and environmental factors outside of individual control. So with research showing that factors such as poverty, poor educational attainment, unemployment and early parenthood can significantly affect the risk of developing a mental health problem it is imperative that society has to recognise, and take action to tackle the huge social inequalities that have such a bearing on people’s well-being. It isn’t right that just because someone grows up in South Tyneside that you are three times more likely to be unhappy compared to someone living in Cheshire East. Particularly, as where you live can also impact so significantly on your chances of gaining access to accessible, timely and quality services. Such that people in Brighton and Hove are five times more likely to access NHS adult or elderly mental health services that people in Shropshire. So not only might you be more likely to get ill, you might also have to stay ill for longer because of where you live. With an election fast looming is it too unrealistic to hope that there will be a true demonstration of political will to tackle the massive health inequalities our country faces.

To tackle disparities don’t blame GPs

Jeremy Hunt has proposed that GPs who fail to diagnose cancer should be named and shamed. This seems to be an utterly nonsensical idea. Surely, the different rates of detection of cancer, which show UK lagging behind other countries in the early detection of cancer cannot be attributed to GPs failing to spot the symptoms?

GPs are highly trained professionals who get presented with a multitude of health problems from their patients every single day. Of those people who present approximately 330,000 people (source: Cancer UK 2014)  are diagnosed annually with cancer.  Of these cases 50% are accounted for by the four most common cancers of bowel, lung, breast and prostate, the remainder can be from a large and very diverse range of cancers. People who present with cancer frequently have symptoms that could denote any number of complaints, and it must be important to consider common explanations as well as more severe and rare causes. In addition, some people with cancer can present with atypical symptoms. Therefore it seems to me that it must be expected, and acceptable, that even with the best performing GP that they may need to see someone several times before they can determine the cause of the problem, or refer on for specialist opinions.

GPs in most cases perform a brilliant job, but as with all jobs requiring human interpretation they may occasionally get it wrong. My worry with this proposal is that GPs will be completely deskilled. To mitigate against the risk they will simply refer on everyone. This will place an enormous strain on specialist services, and also mean that GPs, over time, will become little more that secretariats. The resulting pressure on secondary care will mean that those people will potentially have to wait much longer to be diagnosed, threatening their chances of long-term survival.

This seems therefore to be entirely the wrong solution. Instead, should we not look much more closely at the discrepancies in areas, and work more intensely to tackle the higher propensity for cancer that people from deprived areas have to develop cancer. We must ensure that health promotion is targeted, with motivating messages to ensure that people are equipped to reduce their chances of developing cancers (stop smoking, healthy eating etc.), but also that when invited to participate in screening that they chose to attend, and if they do develop worrisome symptoms that they understand the importance of seeking medical advice. Part of the encouragement in getting help is to ensure that they trust and respect GPs. Something Jeremy Hunt seems to be threatening in a most unwelcome manner.

Come Together for HIV awareness

My teenage years were spent with the AIDS tombstone naysayer advertising. So it’s with a gasp of excitement that I watched the International HIV Alliance’s new campaign to instil in our psyche the ongoing dangers of unprotected sex and contracting the HIV virus.  Sex here is being celebrated in some style (whilst, without casting dispersions, not exactly in a normalising way for the average strictly missionary position practitioner). I love the idea that everyone, of all creeds, races, sexualities need to Come Together to provide around this issue. I hope this advert’s refreshing take on the HIV epidemic will convert titillation into some genuine behaviour change.  For too long HIV has been ignored by health professionals and educationalists. So full credit to the International HIV Alliance’s attempts to get us talking about it once again. PS. And it was great to spot an old school mate as one of the featured pleasure seekers!

Are some cancers better than others?

The Pancreatic Cancer Action charity have today released a new advertising campaign that makes the provocative statement “I wish I had breast cancer”. There intentions are honourable, they are wanting to illustrate the desperately poor cancer survival rates of people diagnosed with pancreatic cancer when compared to people diagnosed with say, breast, testicular or cervical cancer. But the execution of the message leaves me feeling cold. I find it hard to believe that anyone would wish to have any cancer, even a type that has better treatment outcomes and life expectancy. The lack of authenticity is further exacerbated by the decision to have very stylised images of people, and not to attribute the quote to a named individual. I’d like to know if Pancreatic Cancer Action have robust insights undertaken with a sizeable number of people with pancreatic cancer to really give credence to this dramatic message. Without this, to my mind all cancers are bad cancers, and the message offends rather than enrages.

Smoking promotion on our streets

I was taken aback and confused yesterday as I crossed the road in front of this London bus. It’s over a decade since The Tobacco Advertising & Promotion Act 2002 ended cigarette advertising on billboards, posters and the like. So what on earth is this all about. Here’s a packet of cigarettes with the brand name clearly enblazed in metre high letters and confidently peddling its wares down the high street. I stood looking incredulously.

And as I stared I then noticed that the get out of jail free card – this was an advert for e-cigarettes. I’m not interested in debating the relative health advantages of nicotine delivered without tobacco. In fact, although many users of e-cigarettes like to believe e-cigarettes eliminate the harm, my understanding is that it’s not yet possible to categorically state how much less harm they may cause as there have been no large-scale randomised controlled trials into their effects (there are also no regulations to standardise what manufacturers are/are not allowed to put in them) . But what I am very interested in is that a product that looks so remarkably similar to a product that has irrefutable health consequences is now being allowed to be promoted so openly.

Surely it makes a mockery of the government’s annual high cost stop smoking campaigns if smoking cigarettes can be normalised by continuing to appear on our streets. Whilst it’s still unproven whether e-cigarettes help smokers cut down from normal cigarettes we do know that images of cigarettes can trigger cravings and smoking behaviour. So if there’s any chance that images of e-cigarettes (especially when masquerading closely as normal cigarettes) may encourage young people to experiment with either form, or motivate a smoker to lit up another fag, them decisive action is needed. I would urge the government to urgently introduce much tighter regulation of the advertising of e-cigarettes. Let’s not allowed e-cigarette advertising any chance to make any form of smoking more familiar, acceptable and desirable.

Isle of Wight breastfeeding and smoking in pregnancy work attracts attention of Public Health England

We were delighted to hear that Duncan Selbie, Chief Executive of Public Health England was today visiting the Isle of Wight today to learn about local efforts to increase breastfeeding rates and reduce the high rates of smoking in pregnancy. We have had a long relationship with the Isle of Wight Public Health team and in 2012 undertook a significant social marketing project to understand the attitudes and behaviour of mothers to be and new mothers around breastfeeding and smoking. The findings and recommendations from our study have formed the basis for a new strategy and action plan which is now being successfully rolled out.  This has included embarking on the UNICEF Baby Friendly Initiative, embedded staff training, working more closely with children’s services and Children’s Centres and improving the information available. We are pleased the impact of this work is being nationally recognised. Simon Bryant, acting director of Public Health, says about the visit: “We are looking forward to welcoming Duncan Selbie and providing him with an overview of our work and the particular successes we have had on the Island in meeting local health needs.”

The recent MMR outbreak – what do we really know about the choices parents have made?

There are now over 850 cases of people infected with measles in southwest Wales and one linked death. It is reported that 330,000 children aged 10-16 years old remain unvaccinated and the Department of Health have launched a massive vaccination drive.

The Times are reporting ‘one million children may not have received the full course of the MMR vaccine, in large part because of discredited fears it leads to autism’ and other news outlets are making the same foregone conclusion that the unvaccinated teenagers are the result of informed decision-making by their parents who weighed up the Andrew Wakefield ‘evidence’ published in 1998 and decided they didn’t want to take any possible risk with their children.
It would seem to be an obvious connection to make. Back in 1998 there was a monumental exercise in scare-mongering with newspapers, TV and radio catapulting Wakefield’s scientific paper published in a specialist journal into every family’s home. It is thought that the impact of his supposed findings have extended for years, even despite Wakefield subsequently being struck off by the General Medical Council for misconduct.

It does seem to be an obvious connection to make that the parents were swayed by the autism-link arguments are opted not to have their children vaccinated.We wonder though whether this assumption has been put to the test by actually asking the families involved?

Our work for the NHS and health charities on a broad range of issues reveals time and time again the high levels of apathy that people have about making conscious decisions to maintain or promote their health. Despite the overwhelming case for eating fruit and vegetables, reducing alcohol intake, stopping smoking, attending screening and the list goes on, people regularly do nothing to adopt the behaviours that are recommended by the evidence. In part this can be because they develop ways to dispute the macro, population-level statistics which are the basis for much government guidance.  For every official recommendation some people point to their own micro ‘evidence’ to disprove what they are being told, such as their 90 year old lifelong smoking grandfather, or burger and chip eating mother who has no problems with her heart not diabetes. So it could well be the case that for some people, the evidence for vaccination is not meaningful enough to overcome their apathy.

It might be the case that for some of the parents they don’t believe in the benefits of vaccination in general, rather than just MMR specifically? Given past vaccination programmes have been so successful at almost eradicating certain diseases, people may have become complacent and even disbelieving that their children is at a genuine risk,  or that the impact of the disease is really so catastrophic. So do we know how many of the teenagers without the MMR vaccine have also not received protection for other diseases such as polio, diphtheria, tetanus, whopping cough, meningitis C? For it may be that for some parents feel the benefits of vaccination are too low.It’s possible too that we could be overlooking a host of real practical problems that some parents may experience in getting their children vaccination, such as not being able to reach the clinic or keep their appointment because of transport issues, work commitments, or other illness at that time.

There could too be demographic characteristics, beyond their age cohort, that link these young people and their vaccination behaviour and attitudes. Are there revealing patterns to where are they are in the country, or their income level, or educational attainment of the family that might this help to explain the attitudes and behaviour that have prevented vaccination?

So is it the case that this cohort of parents with young children in the late 1990s and early 2000s have been influenced solely by the the Wakefield MMR and autism debate? Taking a deeper look and unlocking the motivators and barriers to taking up particular health behaviours is complex, but ultimately absolutely essential.  We urge the health officials behind the current MMR vaccination drive to ensure they are truly reaching parents and young people with messages that will speak to how they are seeing the issue.

To improve cancer survival rates British stoicism must be challenged

The British Journal of Cancer has today reported on a study of 20,000 people across six developed countries about their knowledge of cancer symptoms and motivation to seek help. The results provide cultural evidence to explain why the UK’s cancer survival rates are the lowest of Australia, Canada, Denmark, Norway and Sweden, despite similar levels of awareness about cancer symptoms and access to medical professionals and treatments. British respondents are more reluctant to seek help, and by failing to seek help early, if at all, their cancer is detected at a later stage where treatment and survival can be comprised. This comes as no surprise to us, as our work talking to people with lung cancer and bowel cancer echoes these findings. So many people have said to us that they would feel embarrassed to share their symptoms, they are fearful of wasting doctors’  time, and worried about not been a serious enough case when compared with others. Public health and other health promotion initiatives have tried to tackle these barriers and reinforce the importance of seeking help with recognised symptoms.  And yet, as this report shows, the public aren’t convinced and they stay away, with the result that over 5000 people are losing their lives unnecessarily (if we were to match the survival rates of other countries). It seems to us that whilst the public feel that our GPs are over-worked and appointment times restricted, that they will be reluctant to be seen to contribute to this problem. And so we must convey that health professionals are both approachable and accessible. Older people in particular want to be granted ‘permission’ to visit. Realistically, this can’t come from GPs. We all know the pressures they face, and even more so with their commissioning responsibilities. Isn’t it time then for practice nurses and health care assistants to be given greater opportunities to provide a frontline service, that is steeped in being personal, caring and welcoming. And for this to become an expected norm amongst patients to see nurses rather than doctors in the first instance? Without a fundamental rethink, it doesn’t seem otherwise very realistic to expect the public to swallow their somewhat misplaced sense of concern for GPs.

What impact will the new government stop smoking campaign have on quit rates?

This week the government has launched their new stop-smoking advertising. Featuring a cigarette that mutates into a cancerous tumour, the message to smokers is stark ‘if you smoke you increase your risk of developing cancer’.

The £2.7m campaign will feature across TV, billboards and online for the next two months. Smokers are encouraged to visit their local pharmacies to get a quit-pack.

It follows-on from the government backed Stoptober campaign which encouraged a mass quit attempt, and is reputed to have had 270,000 sign-ups (although there are no published statistics on successful four-week quitters at the end of the month).

Given that smokers have been calculated to contribute to over a quarter of all cancers it’s no surprise that the government is taking action.

These high profile, co-ordinated campaigns have an important contribution to make in providing a trigger for smokers to attempt to quit, as well as shifting our culture from one that has condoned smoking for most of the last century, to one that is more condemning.

We have experience of speaking with groups of smokers and from them we have gathered some interesting attitudes and behavior that providing valuable insights into motivators and barriers to quitting.

  • Smokers know the population-wide risks that are associated with smoking. However, they are skillful at deflecting the personal risks by celebrating the long ‘healthy’ lives of other smokers they know. The macro-data about the diseases smoking causes need to be made genuinely believable and relevant for each smoker.
  • Smokers can have a tendency to deflate the impact of smoking as compared with other risk-taking behavior, such as the consumption of drinks or drugs, which reduces their compulsion to take action, and heightens their sense of injustice that society ‘has got it in for smokers’.
  • Smokers feel that smoking provides them with ‘me’ time and that they have an entitlement to this pleasure, particularly if they are facing adversity in their life. Stopping smoking must therefore provide a suitable alternative that can become similarly highly valued.
  • Smokers who are attempting to quit feel they are easily derailed from their efforts by small set-backs. They require immediate encouragement, often from multiple sources, to persevere rather than opt out of their attempt.
  • Smokers who provide regular carbon monoxide readings find this a very motivating way to reducing, or ceasing their smoking.
  • For some smokers, nicotine replacement products, and other quitting aids can be essential props to becoming smoke free. The free, and easy availability of such products is therefore essential.
  • Smokers who are/have attempted to quit say that advertising provided a timely ‘reminder’ or ‘nudge’ to take action having previously contemplated wanting to stop. Impact on ‘committed’ smokers was minimal.
  • Smokers are not generally motivated to quit by the cost savings that they will make. Despite the high, and ever rising cost of cigarettes they are often perceived to be ‘good’ value for the pleasure they provide.
  • Smokers who would like to quit, but who live with other smokers who are not willing to stop, find it extremely difficult to sustain their efforts, and in most cases rarely succeed in their attempts. Stop smoking services need to be better able to take a co-ordinated whole household approach.

To us, the insights we have gathered from the public, illustrate strongly how it is essential that stop smoking campaigns need to combine national high profile messaging and reminders of the perils of smoking and the quit tools available, with a more local, personalised and ongoing support service that is tailored to the needs of particular smoking groups. Without this, advertising alone it’s unlikely to achieve sustained change.

From April-September 2012 we spoke with young women on the Isle of Wight who smoke whilst pregnant. We used our findings to draw up recommendations for adaptations to the local NHS stop smoking service. This builds on previous smoking research undertaken with a broader cross-section of adults in North-East Essex and people with lung cancer in the South-West of England.

World Aids Day

On 1 December it is World Aids Day, an event that has been marked around the world for over twenty years, and which is synonymous with the red ribbon – the first of what are now a plethora of ’cause-related’ badges, ribbons and wristbands. Back in 1989, I was just sixteen, and along with three friends, I was chosen by my school to visit London for an AIDS education event. I spent the day hearing from scientists, campaigners and people living with HIV. They inspired us to return to our school and talk about the disease, the risks and encourage safe sex. So, armed with facts and inspired by the personal stories, I returned on a mission to demystify the disease and make it real for my friends. Talking about using a condom in school assembly certainly helped me gain some confidence in public speaking.

Looking back, I realise it was my first taste of communicating public health messages to an audience. I now have almost twenty years delivering behaviour change programmes, particularly in the health arena.

It’s a useful reminder to recognise why that day continues to be so memorable. HIV was presented as being relevant and meaningful to the lives of students living in the UK. And the messages were communicated directly, and with conviction, by young people affected by the disease, powerfully illustrating the strength of the ‘personal’ to build connections. We were also made to feel like we had the ability to think, act and change other’s hearts and minds, and as a teenager I found that extremely motivating.

These elements have subsequently been the essential building blocks of a broad range of health campaigns I’ve worked on; from reducing the stigma and discrimination around mental health problems, to increasing breastfeeding and reducing smoking.

HIV in the UK no longer makes headline news. Although 90,000 people in the UK, more than ever, are living with HIV, scientific advancements have meant the detection and treatment of the disease is almost unrecognisable from the 1980s. And that’s serious cause for celebration. I hope though that the low priority it is now accorded won’t come back to haunt us as current and future generations of young people grow up without the memory of the unforgettable early HIV education campaigns.