Support for Pell from certain quarters (less from others)

Less than wholehearted support from this quarter.

Support from the great and the good in the Scottish Parliament:

*S4M-02252 Richard Simpson: Smoking Ban Reduces Premature Birth Rate— That the Parliament welcomes the report by the Centre for Population and Health Sciences suggesting that there has been a 10% reduction in the country’s premature birth rate; notes that the report has associated this with the introduction of Scotland’s ban on smoking in public places, which was introduced in 2006; understands that the study was based on data collected over 14 years from more than 700,000 women; notes that the report comes at the same time as information claiming that, since the successful introduction of the smoking ban in public places, there has also been a reduction in hospital admissions arising from acute heart attacks; looks forward to the implementation of the further tobacco control measures that the Parliament has passed to discourage smoking, and believes that significant inequalities remain in the distribution of those still smoking, which it believes to be a major public health challenge for Scotland.

Supported by: Hugh Henry*, Patricia Ferguson*, James Kelly*, Sarah Boyack*, Jackson Carlaw*, Jean Urquhart*, Helen Eadie*, Stewart Maxwell*, John Park*, Malcolm Chisholm*, Anne McTaggart*, Paul Martin*, David Torrance*, Patrick Harvie*, John Mason*

It is surely inaccurate to describe the difference between 55 and 65 premature births per thousand live births as 10 per cent. A decline from 65 to 55 births may have taken place in the period Pell examined but they don't support her case – partly because the drop is already under way before the ban is introduced. This represents a decline in the numbers affected by about one-tenth but Dr Simpson categorically states that the premature birth rate has declined by 10 per cent. (This of course might help to explain how Pell achieved her 17 per cent drop in heart attack admissions.)

Source

This piece from BBC Scotland in 2009 is also relevant because it states that the premature birth rate was increasing up to 2005: a change associated with a growing number of expectant mothers with diabetes. It does not deal with the post-2006 period. It also records the rates in the 1980s as around 54 per 1000, which means that the peak of 62/3 was not typical of the pre-smoking ban premature birth rate. In any case the variation between 54 and 62 per thousand is very small in percentage terms.

Bumpy ride for UN conference on non-communicative diseases

It should surprise nobody that a global conference on non-communicative diseases fails to get to the top of most people's priorities. Former editor of the British Medical Journal Richard Smith discusses the forthcoming UN summit on non-communicable diseases (September in New York) – admits to no little surprise that there seems to be limited enthusiasm for it and contemplates the merits of a global resolution on this issue that is unsupported by any funding.

The summit focuses on four risk factors: tobacco use, alcohol misuse, physical inactivity and inadequate diet. These are leading factors in cancers, cardiovascular disease, COPD and diabetes.

Lancet editor Richard Horton observed earlier this year that the non-communicable disease agenda lacks the urgency of other issues.

Although 80% of NCD deaths take place in low and middle-income countries, the fact is that for the 50 or so poorest countries in the world an unfinished litany of problems remains—infectious diseases, maternal and childhood illnesses, and unchecked population growth. NCDs come bottom of this list.

Richard Smith still seems to feel it is worth while keeping on the table as an issue for the NCD Alliance. But the NCD Alliance seems to be losing patience with the rest of the world:

A particular problem for the NCD Alliance, a quickly formed global body of organisations concerned about NCDs, is that the outcome document lacks clear targets, meaning that member states can easily slide away from doing anything. There are also disagreements over follow up and the need for partnerships. The alliance says that its time to “stop being polite.” They want outrage.

The issues that concern the NCD Alliance seem far too important to leave at the table of a hastily formed group of non-governmental organisations, that appears to think it should be an authority on global health issues ... an authority with teeth, that can enforce its will on member states. What can such an alliance actually do? Adequate food cannot be guaranteed by a non-governmental body without the willing cooperation of many other actors. Such a body can recommend good diet, but where malnutrition is a recognised issue it won't necessarily help matters to have yet another body declare that everyone needs a balanced diet.

All an international body can do is demand policy changes. Any other kind of intervention costs money.

What kind of policy changes will be advocated? Is this kind of scenario in less developed countries really going to be helpful or relevant?

Mr Smith seems a little surprised that NCDs don't get the attention from the general public that was given to AIDS. The global health agenda seems to have turned upside down since then.