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(1) Thousands of deaf patients struggling to access basic health care (2) Reason for sickness absence can predict employee deaths (3) Should companies with unhealthy products be regulated to protect health?
(1) Thousands of deaf patients struggling to access basic health care (Personal View: Actions speak louder than words) http://www.bmj.com/cgi/content/extract/337/sep30_2/a1882
Thousands of Deaf* patients are receiving inadequate healthcare because they are struggling to communicate with healthcare professions, say experts on bmj.com today.
There is a basic lack of deaf awareness and appropriate communication support by healthcare professionals, write Michael Paddock and colleagues from Kings College London School of Medicine and South West London and St George's Mental Healthcare NHS Trust.
It is estimated that there are nearly nine million people in the UK who are hard of hearing - almost a sixth of the population. Yet studies have shown that 70% of Deaf patients have no interpreters in A&E consultations and 28% of Deaf people avoid going to see their general practitioner because of poor communication.
In particular, it is Deaf individuals with mental health problems that suffer, say the authors. Well over three million (up to 40%) Deaf people experience mental health problems at some point in their lives compared to one in four of the general population.
But evidence shows that an increase in the use of signed communication appears to be associated with a decrease in the prevalence of mental health problems.
The authors call for basic instruction in Deaf awareness and "appropriate communication tactics" to be added to the medical curriculum and taught to medical students to ensure that access to essential health services is not restricted for these individuals.
They point to a programme of Sensory Awareness development and training that is already part of the undergraduate medical curriculum at King's College London. The programme aims to equip students with the skills to enhance their communication with Deaf and hard of hearing patients, such as checking hearing aids and maximising communication with patients who lip-read. In addition, a special study module, 'Deaf Awareness and British Sign Language', is offered in year three.
If, as the General Medical Council claims, the undergraduate medical curriculum is to produce competent physicians who "listen to patients and respond to their concerns and preferences" and "give patients the information they want or need in a way they can understand", then other medical schools must follow the example of King's College, conclude the authors.
Notes to Editors: *The use of the term Deaf (with an uppercase D) is used to describe individuals who were born Deaf and whose preferred form of communication is British Sign Language.
Contact: Michael Paddock MSc, Kings College London School of Medicine, London, UK Email: michael.paddock@kcl.ac.uk
(2) Reason for sickness absence can predict employee deaths (Diagnosis-specific sickness absence as a predictor of mortality: the Whitehall II prospective cohort study)http://www.bmj.com/cgi/content/abstract/337/oct02_2/a1469 (Editorial: Medically certified sickness absence)http://www.bmj.com/cgi/content/extract/337/oct02_2/a1174
Employees who take long spells of sick leave more than once in three years are at a higher risk of death than their colleagues who take no such absence, particularly if their absence is due to circulatory or psychiatric problems or for surgery, concludes a study on bmj.com today.
Previous research shows that medically certified sickness absences may well capture the full range of illnesses employees experience and that they could be a good global measure of health differentials between employees. It has been suggested that the specific reasons for absence such as psychiatric problems or heart disease may improve the prediction of premature death.
Jenny Head from University College London and colleagues investigated whether the reason for sickness absence improved the prediction of death compared with overall sickness absence irrespective of diagnosis.
They obtained sickness absence records for 6,478 British civil servants between 1985 and 1988 and analysed associations with death until 2004.
They found that deaths increased as the medically certified absence rates (spells of more than 7 days) increased. The almost 30% of men and women who had one or more medically certified absence in three years had a 66% increased risk of premature death than those with no such absence.
The authors report that by including the diagnosis for sickness absence they significantly improved the prediction of the risk of death. For instance, employees taking sickness absences due to circulatory disease were four times more likely to die prematurely than their colleagues with no absence. Those who took absence due to psychiatric diseases were nearly twice as likely to die prematurely, and those with a surgical operation diagnosis were more than twice as likely.
Interestingly, one or more spells of absence with a psychiatric diagnosis was predictive of a two and a half fold increase in cancer related death.
However, employees taking spells of sickness absence with a musculoskeletal diagnosis were not at increased risk of death compared to their colleagues who took no absence.
The authors conclude that the monitoring of reasons for sickness absence could contribute to identifying groups at increased health risks and who need a targeted intervention.
In an accompanying editorial, Johannes Anema and Allard van der Beek from the VU University Medical Centre in the Netherlands, suggest that specific diagnostic information on sickness absence could provide general practitioners with "a useful biopsychosocial tool" to identify workers with an increased risk of serious illness or risk of death.
In addition, Anema and van der Beek say that this tool could also be used to identify employees with work related health problems such as stress and high job demands, for targeted intervention by occupational physicians.
Contacts: Jenny Head, Department of Epidemiology and Public Health, University College, London, UK Email: j.head@ucl.ac.uk Editorial: Johannes Anema, Department of Public and Occupational Health and EMGO Institute, VU University Medical Centre, Amsterdam, Netherlands Email: h.anema@vumc.nl
(3) Should companies with unhealthy products be regulated to protect health? (Head to Head: Should we use regulation to demand improved public health outcomes?) Yes: http://www.bmj.com/cgi/content/extract/337/oct02_2/a1750 No: http://www.bmj.com/cgi/content/extract/337/oct02_2/a1761
Should businesses that sell products which are responsible for a huge numbers of deaths, illness and injury, such as tobacco and junk food, be held accountable and made to improve public health? Two experts debate the issue on bmj.com today.
Stephen Sugarman a Professor of Law from Berkeley University in California, believes that businesses will only act if their profits are threatened, so current voluntary agreements are insufficient. Instead, he suggests letting governments tell businesses what outcomes they want from them and leaving them to work out how best to achieve regulatory targets.
This new approach, performance based regulation, would focus directly on outcomes. For example, junk food sellers would have to make sure there were fewer obese schoolchildren, car manufacturers would have to reduce the number of fatal road crashes, and tobacco companies would be compelled to reducing smoking prevalence.
If companies do not achieve their goals they would face substantial charges. Given this scenario, it is probable that companies would become very creative in devising new inventions to tackle these problems, writes Sugarman.
He argues that while public health leaders should accept business as an ally they should also wake up to the fact that voluntary cooperation will never achieve enough. He says: "Performance based regulation occupies the middle ground - a third way. Let society set legally enforceable goals and then let enterprises loose to accomplish them."
But Stig Pramming, Executive Director at the Oxford Health Alliance, argues that there is no guarantee that regulation will bring about behavioural change. Selling healthier snack food will not guarantee a fall in obesity levels and increasing bike lanes will not definitely change traffic patterns.
He maintains that businesses have changed - they may not be angels but they are increasingly transparent and cannot afford to neglect their corporate social responsibility, he adds.
While it would be foolish to believe that businesses don't put their profits first, he believes that it is down to activists to be organised and persuasive in getting involved with companies.
Using the example of his own organisation, the Oxford Health Alliance, which engages business, health professionals, policy makers and other stakeholders as equal partners in finding solutions to public health problems, he says that many major companies now see the business sense of promoting healthy choices and behaviours.
He points to examples such as Sainsbury's, which has invested millions of pounds in the development of a childhood obesity programme called MEND (Mind, Exercise, Nutrition … Do it); and PepsiCo which has merged with Quaker Oats and bought the fruit juice company Tropicana to move away from sugary drinks to healthier alternatives.
Pramming concludes: "Cooperation is an urgent priority, and we must act to ensure that business is part of the solution. Regulation is no substitute for collaboration."
Contacts: Stephen D Sugarman, School of Law, Berkeley, California, USA Email: sugarman@law.berkeley.edu Stig Pramming, Executive Director, Oxford Health Alliance, London, UK Email: stig.pramming@oxha.org
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