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Duncan Selbie's Friday message – 10 Feb 2017

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Dear everyone

Last Friday we published our first digital strategy setting out how we will work across government, with our partners and across PHE to take advantage of the increasing opportunities of digital technology and the impact this is having on our everyday lives, including our health and wellbeing. This is a work in progress and we would welcome comments.

On Tuesday we published new data to support local decision making, with updates to the Local Alcohol Profiles and the Local Tobacco Control Profiles for England. Steep variation between socioeconomic groups remains the obvious message with, for example, the rate of deaths specifically related to alcohol for the most deprived people more than double that of the least deprived, and 28% of routine and manual workers still smoking, against a national rate of 17%. We have also published several updates to the Public Health Outcomes Framework, including a number of new indicators.

On Wednesday, the Director of our National Infection Service Professor Derrick Crook and I visited Germany's national public health agency, the Robert Koch Institute. We shared our plans for high containment science with Germany due to open the first wholly state owned laboratory with category 4 capability. We also shared notes on whole genome sequencing, data science and international collaborations. The RKI is highly respected and we look forward to strengthening our partnership.

And on Thursday I visited RIVM, the renowned National Institute for Public Health and the Environment in the Netherlands. We shared our laboratory plans, discussed AMR and environmental public health and learned about their experience undertaking an international peer-to-peer evaluation by the International Association of National Public Health Institutes, something we plan to undertake ourselves in June. This international benchmarking exercise will help guide our development across the full range of what we do as we mature in our role.

Also on Thursday we welcomed 500 delegates from across local government, primary care, academia and the public, private and voluntary sectors to the annual NHS Health Check conference. A major topic of discussion was the report from the Expert Scientific and Clinical Advisory Panel (ESCAP) published the day before, outlining the findings of a recent review of the emerging evidence on the NHS Health Check.The report shows that the programme is succeeding in delivering its objectives of detecting disease earlier and tackling health inequalities by reaching people from poorer communities and high risk ethnic minority groups. There are also promising findings showing that the programme can prevent disease, but the limited scope and quality of this early evidence means that the true extent of the programme's impact remains unclear, and ESCAP's recommendations seek to address this.

We have also published new training resources to support the NHS in advising people over 65 having an NHS Health Check that dementia is not an inevitable part of ageing, and that simple life style changes that are good for the heart are also good for the brain.

New research funded by Cancer Research UK and carried out by UK and US scientists was published in the Annals of Internal Medicine on Monday and adds to the growing evidence that e-cigarettes carry a fraction of the risk of conventional cigarettes. This research supports the considered position of the wider public health family in England that e-cigarettes can provide significant health gains for smokers who switch completely.

NHS England has created a short animation for NHS staff, the wider public and patients to help explain how sustainability and transformation plans seek to improve health and care services for local people. Do take a look.
And finally, I am on half term with my family next week and so my next message will be on Friday 24 February.

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  1. Comment by Kate Maneville, Consultant in Public Health posted on

    I'm surprised not to see the other major e-cigarette study published last week mentioned here for balance. This study "E-cigarette use as a predictor of cigarette smoking: results from a 1-year follow-up of a national sample of 12th grade students" published in Tobacco Control found that among teenagers who had never smoked a cigarette at baseline, recent vapers were more than four times more likely to report past-year cigarette smoking at follow-up, even among youth who reported the highest possible level of perceived risk for cigarette smoking at baseline. The combined results of both studies show that while e-cigarettes may have benefits for current smokers, they may also act as a gateway to creating new smokers among young people. The public health benefits are far from clear.

    • Replies to Kate Maneville, Consultant in Public Health>

      Comment by Martin Dockrell, Tobacco Control Lead posted on

      Thanks for your comment. You might be interested to take a look at the monthly critical update of the evidence from the UK E-Cigarette Research Forum, established by PHE, Cancer Research UK and the UK Centre for Tobacco and Alcohol Studies as an arena to discuss the latest evidence and identify research gaps and priorities.

      In line with the considered position of the wider public health family in England that e-cigarettes can provide significant health gains for smokers who switch completely, we think it is important to make clear that the evidence is very different from a growing perception among the UK and US public that e-cigarettes are as dangerous as smoking tobacco. PHE seeks to maximise the opportunities presented by e-cigarettes while we manage the risks. The growing, but mistaken public perception that they are as risky as traditional cigarettes means fewer people are likely to try e-cigarettes or to switch to them completely.

      An important feature of the research we cited was that it came from leading US and UK authorities including Roswell Park and CDC and underscores the growing consensus that e-cigarettes carry a fraction of the harm of smoking. However, there is no consensus that e-cigarettes are acting as a gateway to smoking among youth and in fact several authors have challenged whether the US study you mention justifies the conclusion that e-cigarettes may have a gateway effect. A study published by De Lacy et al []last week concluded “e-cigarette use among youth is an emerging public health issue, even though there remains no evidence that it represents a new pathway into smoking.”

      We understand a new paper on UK wide data is to be published shortly and we will continue to scrutinise the data as it emerges.