A damehood for Margaret Whitehead

Professor Dame Margaret Whitehead From www.crewechronicle.co.uk

Professor Dame Margaret Whitehead
From http://www.crewechronicle.co.uk

This is good news for the public health and environmental health communities. The Crewe Chronicle reported last month (I’ve only just spotted this) that Professor Margaret Whitehead was awarded a Damehood in the New Year’s Honours List. Professor Whitehead is head of the University of Liverpool’s department of public health and policy and was recognised for her outstanding contribution to society’s understanding of health inequalities, with a significant influence on public health internationally.

Students of environmental health will recognise the Dahlgren and Whitehead model of the determinants of health which suggests the relationships between the individual, their environment and health outcomes.

It’s always nice to put a face to a name.

And if you’re interested, the model is visually represented thus:

Social determinants of health - Dahlgren and Whitehead 1991

Farmer says refrigerating raw milk as soon as it leaves the goat helps kill potentially harmful bacteria.

Er, no it doesn’t.

This news item comes from Alaska, home of such intellectual luminaries as Sarah Palin. Here, a couple of goat farmers have set up one of those infamous herd-share arrangements to supply raw milk to the small town of Petersburg. But why are people wanting to drink raw goats milk? According to the farmer, Tabitha Nelson, it’s because theirs is “quality milk that doesn’t have all that industrialized stuff in it”.

Tabitha Nelson, child and goats

Tabitha Nelson, child and goats

And people buy into this tosh. According to the same news report, Petersburg resident Gina Esposito owns a share of the milk and it’s worried about getting sick from processed milk. “The more you learn about where food comes from, the more paralyzed you feel about what you want to buy,” she said.

For those who haven’t heard of it before, herd-sharing is one of the ways some American states allow people to get around food safety laws prohibiting the sale of unpasteurised milk and milk products. All you have to do is buy a share in the herd and bingo! you’re no longer a customer but an owner and you’re merely sharing the products as a dividend of ownership.

I’ve written before about a cow-sharing scam in Tennessee:

The shocking story of an outbreak of E. coli O157 infection associated with the consumption of raw milk came to my attention as a result of a story on US Food Safety. Nine children became ill after drinking raw milk from a farm in Knox County, in a state where it is illegal to sell unpasteurised milk. Five of  those children require hospital treatment and three went on to develop the severe, and irreversible, consequences of haemolytic uraemic syndrome (HUS). [read more here]

And in February this year I also wrote about the risks of drinking raw milk.

Later this evening I’ll be posting a link to a YouTube talk I’ve prepared on suchlike nonsense in the realms of rare beefburgers and the dangers of E. coli O157. Watch this space.

By the way, thank to Doug Powell and the excellent barfblog.com for the story. You couldn’t make this stuff up.

Dr Ben Goldacre: on politics and evidence based policy

A good reminder from Rob of what we should always keep in the forefront of our professional minds.

UK Environmental Health Research Network

I write this quickly, at the end of my lunch break before re-entering the world of PhD Chapter 7, the relations between EHPs and politicians! My lunch was made more pleasant by the discovery of this video-clip made by Dr Ben Goldacre for the BBC’s  Newsnight programme:


Here Ben argues that our democracy could be improved by more evidence based policy in politics both to improve practice and to better hold our politicians to account if they fail to deliver. All these arguments apply to our own environmental health worlds, but I would differ slightly in that we need to utilise all the research tools available (not just randomised trials) towards better understanding what works and what doesn’t!

In UK election year I thought the video was also a timely reminder of our eBook (page 7) advice on evidence:

  • Tune your ‘warning antennae’ to alert you every time you see…

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The risks of drinking raw milk

I’ve been getting into a bit of a discussion thread on my Facebook page after posting a link to an article at FoodWorld, about a study which reviewed outbreaks caused raw milk–milk that has not been pasteurized to kill disease-causing germs –in the United States that were reported to CDC from 2007-2012.

Interestingly, I’ve also become aware of a the recent scientific opinion on the public health risks related to the consumption of raw milk. The research was conducted by the European Food Safety Authority’s (EFSA) panel on Biological Hazards and the full opinion can be found here. [EFSA Journal 2015;13(1):3940 [95 pp.]. doi:10.2903/j.efsa.2015.3940]. In summary, the experts reveal some rather startling diseases can be caught from drinking raw milk.

Between 2007 and 2013, 27 outbreaks were due to the consumption of raw milk. Most of them – 21 – were caused by Campylobacter, one was caused by Salmonella, two by STEC (Shiga toxin-producing Escherichia coli) and three by tick-borne encephalitis virus (TBEV).  A large majority of the outbreaks were due to raw cow’s milk, while a few of them originated from raw goat’s milk.

The Panel made a series of recommendations about improving the evidence-base and, most importantly, improving risk communication to consumers so that the hazards associated with consuming raw milk, where it remains legal to place it on the market, are better known and understood. You’ll be pleased to know that Scotland is the one enlightened part of the UK where the sale of raw milk is illegal. Funnily enough, Scotland no longer has outbreaks of disease associated with raw milk. That’s a public health win, because the purchasing decisions are generally made by well-meaning but ill-informed adults and the disease burden is mostly on young children and the elderly.

For a summary (up to 2012) of the situation in the UK regarding the consumption of raw milk and the consequent disease burden, you can read a paper submitted to the Board of the Food Standards Agency. It includes tables on the outbreaks in England & Wales (1992-2011) and Northern Ireland (1984-2011).

Harsh socio-economic conditions affect the genetic health of children

Environmental health practitioners, particularly those who studied and qualified in the last twenty years, will be very familiar with Margaret Whitehead and Göran Dahlgren’s model of the social determinants of health, shown below in the well-known model from their 1991 publication.

Social determinants of health - Dahlgren and Whitehead 1991

Environmental health as a profession works at the interfaces between, generally, people’s living and working conditions and their health and wellbeing. But these are only one set of environmental factors that affect health in terms of morbidity and mortality, and there are other governmental and social actors that can work together to intervene and change the outcomes for real people in the real world. That’s why the new public health arrangements in England are game-changing for the profession and for the health of the public generally, and that’s why finding an evidence-base to target suitable and effective interventions that will really make a difference for people is so important.

A recent paper by Daniel Notterman and colleagues from Penn State University, and published in the Proceedings of the National Academy of Sciences of the United States of America, studied the genetic effects of harsh socio-economic environments on a group of children over a nine-year period. What they found was very striking – there was a statistically-significant shortening of the telomeres on the chromosomes of children who experienced a harsher socio-economic environment than those children who grew up in a more advantaged environment. And these effects were visible by the age of nine.

The story was picked up by several news outlets and New Scientist carried an article on it this week, which caught my attention and drew me to read the original paper.  I wanted to find out what was actually meant by “harsh environment” in the context of the research.

The authors chose a study group of African American children, and boys specifically, for this study. Choosing a single-sex group from a single racial cohort, as in this case, reduces some of the potentially-confounding factors for the study. The authors refer to research which indicates that boys may be more sensitive to negative family factors that girls.

In the context of this study, “harsh environment” means poorer, harsher parenting styles as against more nurturing styles, more changes in family structure particularly parental transitions, a younger mother at birth and poorer maternal educational achievement. A study group of 40 boys was chosen distributed between the harsh environment and more advantaged environments, where there was more stability in the family, a more nurturing parenting style, an older mother at birth and a mother with more educational achievement.

Telomeres are the repeating strings of TTAGGG bases at the ends of the chromosomes which are thought to protect functional genes  from damage during mitosis. Telomere length is a measure of the number of these repeats. Telomere length decreases over lifespan and are thought to be associated with aging and mortality. Therefore, the identification of factors which affect the telomere length in children and at such an early age is important in public health terms.

This study found as follows:

Model 1 (M1) of Table 2 shows that living in a disadvantaged environment was associated with a 19%shorter TL (P = 0.02). The next set of models (M2–M5) show the associations between boys’ TL and each of the environmental measures separately. Model 2 (M2) shows that a
doubling of the family income/needs ratio was associated with a 5% increase in the boys’ TL (P = 0.03). To provide more context for this estimate, in the larger Fragile Families sample the mean income/needs ratio is 0.7 for children at the 25th percentile and 2.7 for children at the 75th percentile, which is equivalent to an 8% difference in TL under this model. As a robustness test for economic conditions, we also examined the association between a boy’s TL and his mother’s education (see M5 in Table 2). Compared with children of mothers with less
than a high school education, having a mother with a high school degree is associated with a 32% increase in a child’s TL (P = 0.006), and having a mother with at least some postsecondary education is associated with a 35% increase in TL (P = 0.005). In sum, family economic status was a significant predictor of a boy’s TL measured in middle childhood. Model 3 shows that a low score on the parenting quality index was associated with a 3% decrease in a boy’s TL. Finally, model 4 shows that being exposed to multiple changes in family structure was associated with a 40% decline in a boy’s TL (P = 0.010).

As Dahlgren and Whitehead also write (Levelling up (part 1): a discussion paper on concepts and principles for tackling social inequities in health, WHO 2007),

… a stepwise, or linear, decrease in health – and not just an extreme group in poor health and the rest in reasonably good health – is seen with decreasing social position and is referred to as the social gradient (Marmot,2004). For example, the health of the populations of Florence, Leghorn and Turin has been followed over a number of years, and the findings clearly show that mortality increases linearly with increasing degree of social disadvantage. This is so both when social disadvantage is measured by the characteristics of individuals, such as education, employment or social class, and when it is measured by deprivation of the area in which people live …

This is a small study, and has some methodological problems, but it strongly suggests that public health workers need to look as closely at interventions in the family circumstances of children as at their physical environments if those children are to achieve their potential for long lives. Making them long, healthy lives is another challenge.

Cow-sharing, a scam to get around public health laws in Tennessee

The shocking story of an outbreak of E. coli O157 infection associated with the consumption of raw milk came to my attention as a result of a story on US Food Safety. Nine children became ill after drinking raw milk from a farm in Knox County, in a state where it is illegal to sell unpasteurised milk. Five of  those children require hospital treatment and three went on to develop the severe, and irreversible, consequences of haemolytic uraemic syndrome (HUS).

The Tennessee Department of Health confirmed today that the strain of E.coli that caused nine children to become ill after drinking raw milk obtained from a farm near Knoxville has been matched to animal waste collected at the dairy.

This has been a major outbreak investigation for the environmental health team in Knox County, with the investigation involving an on-site inspection of the farm, interviews of 88 households that purchased milk from the farm and laboratory analysis of samples and materials to compare bacterial strains.

So how come the raw milk was on sale to the public? Answer: Continue reading

Top drinks in the west of Scotland

I’m currently sitting waiting for a clinic appointment in Glasgow. There’s a poster in the waiting area giving unit and calory information for a range of drinks. The list is:
* Buckfast
* Vodka
* Smirnoff Ice
* Whisky
* Tennents Super Lager
* Frosty Jack
* Wine
Did you know you can get your daily calorific intake from just one litre of vodka?