Councils eye public health funds

23 November 2010 Last updated at 20:53 ET By Nick Triggle Health reporter, BBC News

Cash-strapped councils are seeking control of �4bn of NHS funds earmarked for public health, the BBC has learned.

Over 150 public health directors in England will be transferred from the NHS to local government under plans to be set out by ministers next week.

They are expected to get a ring-fenced budget to spend on projects to combat problems such as obesity and smoking.

But local government chiefs want the money put into the general pot as their funding will be cut by 26% by 2014.

Public health directors are currently employed by primary care trusts. But as these will be scrapped with the introduction of GP consortiums in 2013 it has been decided that public health should revert back into local government - as it was before 1974.

Lobbying

Health Secretary Andrew Lansley has long-argued the public health budget should be protected as it is often raided during tough financial times because the benefits of investment take a long time to be realised.

But councils have been lobbying in meetings with civil servants and ministers as well as through a formal consultation for the money not to be reserved.

It comes after local government was one of the worst hits areas of the public sector in the recent spending review.

Funding from central government is due to fall from �29.7bn to �24.2bn over the next four years, a cut of more than a quarter once inflation is taken into account.

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"Start Quote

We know the strain councils are under, but I think most public health directors would say it is right that the money is ring-fenced, certainly in the short-term. Otherwise the temptation for councils would be to shore up their existing budgets"

End Quote Dr Frank Atherton Association of Directors of Public Health

The Local Government Association, which represents councils, has argued that they should be free to decide how money is spent as the government has promised to devolve power down from the centre.

It has also claimed that since much of the public health agenda cuts across council departments - for example public health directors work with highways and planning over things such as cycle networks and with schools over issues such as school meals and healthy lifestyle promotion - it could be counter-productive to set aside a specific pot.

Councillor David Rogers, chairman of the LGA's community well-being board, said: "Far from protecting resources for public health, a ring-fence may have the reverse effect and be viewed as the total amount of money which should be spent on making people healthier.

"Public health needs to be at the heart of what all councils do and not seen as a separate function."

He added councils were "fully committed" to tackling public health problems, but said they needed "financial freedom" to decide what was in their residents' interests.

He said the LGA would continue putting its case even if the white paper proposes the ring-fencing which currently amounts to just under 4% of the NHS's �104bn budget.

Dr Frank Atherton, president of the Association of Directors of Public Health, said he understood the position local government was taking.

"We know the strain councils are under, but I think most public health directors would say it is right that the money is ring-fenced, certainly in the short-term. Otherwise the temptation for councils would be to shore up their existing budgets."

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Binge drinks 'raise heart risk'

23 November 2010 Last updated at 20:52 ET

Binge drinkers have a risk of heart disease twice that of people who consume the same amount of alcohol but more steadily, researchers say.

The study compared 10,000 male drinkers from "booze-bingeing" Belfast and "moderate" France over 10 years.

It concluded that downing lots of alcohol in one or two sessions is worse than drinking more regularly in a week.

Experts said the British Medical Journal work reinforced what was known but was a wake-up call for bingers.

Amy Thompson, senior cardiac nurse at the British Heart Foundation, said: "This reinforces what we already know - that drinking high levels of alcohol can be harmful to your heart.

"It's important to avoid binge drinking and it's better to have a small amount of alcohol regularly rather than large amounts in one go. If you do drink, it's important to keep within the recommended limits."

The official advice in the UK is that women should not regularly drink more than two to three units (about two glasses of wine or one pint of beer) a day and men should not regularly drink more than three to four units a day.

In the study, some 9% of the middle-aged men in Belfast were binge drinkers, consuming at least three pints of beer or five glasses of wine in one sitting, mostly on a weekend, compared with 0.5% of those in France.

The French men tended to drink less alcohol in each sitting but drank more regularly.

Three-quarters of the French men drank daily, compared with 12% in Belfast.

The researchers found the men who were binge drinkers had nearly twice the risk of heart attack or death from heart disease compared with regular drinkers over the 10 years of follow up.

Professor Jean Ferri�res, from Toulouse University Hospital, who carried out the research, believes the irregular pattern of drinking is to blame.

Another reason for the higher risk of heart disease in Belfast, said the authors, could be that more men there tended to drink beer and spirits than wine - the opposite of what the men in France tended to drink.

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Drug 'reduces' HIV infection risk

23 November 2010 Last updated at 15:13 ET By Neil Bowdler Science reporter, BBC News

A drug used to treat HIV-positive patients may offer gay and bisexual men some protection against contracting the virus, the authors of a new study say.

Trials of the combination drug Truvada among nearly 2,500 men suggested it could reduce the chances of male-to-male HIV infection by 44%.

Those using the drug regularly could further reduce the risk of infection, it was claimed.

The study is published in the New England Journal of Medicine.

Pills and condoms

Truvada is the trade name of a drug manufactured by the California-based company Gilead Sciences Inc which combines two antiretroviral drugs, used to treat Aids.

But this new study looks at whether it could be used to prevent HIV infection in the first place.

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"Start Quote

We need to know if we get similar results in women as well as in heterosexual men, which we have reason to believe we will"

End Quote Dr Anthony Fauci Director, National Institute of Allergy and Infectious Diseases

Almost 2,500 gay or bisexual men were randomly selected in Peru, Ecuador, Brazil, South Africa, Thailand and the United States. Half were given the pill, half were given dummy tablets.

All the men were also given condoms and counselling on safe sex.

What the researchers found after about a year of testing was that the drug appeared to cut male-to-male HIV transmission by 44%, when the group taking the pill was compared with the placebo group.

Those who were took the pill regularly were deemed to have reduced their risk of infection further, by up to 73%, and blood tests were run to confirm this relationship between pill-usage and protection levels.

The research was funded by the Bill & Melinda Gates Foundation, and the federal US body, the National Institute of Allergy and Infectious Diseases (NIAID). The pills were donated by their manufacturer.

NIAID director, Dr Anthony Fauci, conceded more work needed to be done, but called the results impressive.

"This has been done in men who have sex with men. We need to know if we get similar results in women as well as in heterosexual men, which we have reason to believe we will," he told the BBC.

"We also need to get a long term view of were there any toxicities. We didn't see anything that was significant but we need to follow that for a long period of time."

Questions and concerns

The trial does of course raise questions and concerns. Is it possible, for instance, that the results were skewed by greater condom use in the group that took the pill; and won't such findings encourage some men to dispense with condoms altogether in favour of a drug?

There is also the issue of prohibitive cost of Truvada, which retails in the US for around $36 a day, and which makes the drug unaffordable to many possible users.

Dr Fauci argues that the two groups were fully randomised and says that drugs can only play a complementary role in the war on HIV. Condoms and fewer partners, he said, remain the first line of defence.

"We're hoping that if this does become a useable tool in prevention, then the associated counselling will complement the effect of the drug and stop people becoming cavalier about it and say 'now I have a pill I don't have to worry'.

"That's exactly the opposite of what we want to happen. We want to add something rather than have it replace something."

Sir Nick Partridge, chief executive of the Terrence Higgins Trust, called the trial results "potentially significant".

"It's vital that we expand the ways we can prevent HIV transmission, particularly amongst those most at risk," he said in a statement. "This trial proves that HIV treatment will have an impact on prevention, but that it's not ready for widespread use yet.

"Three major hurdles are still going to be its cost, the risks of drug-resistant strains of HIV developing and taking a drug treatment every day."

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Vatican clarifies condom comment

23 November 2010 Last updated at 09:49 ET

The Vatican has clarified Pope Benedict XVI's comments on condoms, saying their use by men and women to prevent HIV could be an act of "responsibility".

The clarification follows comments suggesting Pope accepted their use only in exceptional circumstances.

But the Vatican's senior spokesman said the key point was taking the life of the other person into consideration.

The comments come from a book based on a series of interviews with the Pope, published on Tuesday.

In the text, the Pope appeared to suggest that condoms could reduce the risk of infection in certain circumstances, such as for a male prostitute.

'Taking responsibility'

The Pope's meaning was questioned because the Italian translation of the book used the feminine form of the word for prostitute, whereas the original German used the masculine.

Vatican spokesman Father Federico Lombardi said he had personally asked the Pope if there was a serious, important problem in the choice of the masculine over the feminine.

"He told me 'No'," Fr Lombardi said. "The problem is this... It's the first step of taking responsibility, of taking into consideration the risk of the life of another with whom you have a relationship."

"This is if you're a woman, a man, or a transsexual," he added.

Despite this shift, the Vatican still believes that changing attitudes to sexuality is the proper way to combat HIV/Aids.

In the book, the Pope says that condoms are "not really the way to deal with the evil of HIV infection".

The Pope's attitude towards homosexuality and artifical contraception has not shifted, with other passages in the book reaffirming the Vatican's opposition to both.

The Roman Catholic Church's traditional opposition to contraception has led to the Vatican being heavily criticised for its position in the context of the Aids crisis.

The book - Light of the World: The Pope, the Church and the Signs of the Times - is based on interviews that the Pope gave the German Catholic journalist, Peter Seewald, earlier this year.

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HIV epidemic 'halted', says UN

23 November 2010 Last updated at 05:58 ET

The number of new HIV infections and deaths from Aids are falling globally, according to new statistics from the UN's programme on HIV/Aids.

There are now signs the epidemic is declining, it says, however, stigma and discrimination continue to cause problems for the estimated 33m people living with HIV.

Last year there were 2.6m new HIV infections.

This is down almost 20% since the peak of the Aids epidemic in 1999.

In 2009, 1.8m died from Aids-related illnesses, down from 2.1m in 2004.

Mixed progress

The report says rates of treatment using anti-retroviral drugs have risen from 700,000 in 2004 to over 5m people in 2009.

Sub-Saharan Africa continues to be the region most affected by the epidemic, with around 70% of all new HIV infections occurring here.

But infection rates are falling, particularly in South Africa, Zambia, Zimbabwe and Ethiopia.

There is a mixed picture in other parts of the world.

Eastern Europe and central Asia show sharp rises in new infections and Aids-related deaths.

And the UN says bad laws and discrimination, particularly in respect to drug users and homosexuals, continue to hamper the fight against Aids.

"We are breaking the trajectory of the Aids epidemic with bold actions and smart choices," said Mr Michel Sidibe, executive director of UNAids.

"Investments in the Aids response are paying off, but gains are fragile - the challenge now is how we can all work to accelerate progress."

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Cold weather deaths show big fall

23 November 2010 Last updated at 06:44 ET By Dominic Hughes Health correspondent, BBC News

The number of extra deaths occurring in England and Wales last winter fell despite the coldest weather for 14 years.

Figures from the Office of National Statistics show there were an estimated 25,400 extra deaths.

That marks a reduction of around 30% on the previous year.

The fall is possibly because while it was certainly cold last winter, there was no big outbreak of seasonal flu.

The figures measure the number of extra deaths that occur between December and March - usually the coldest months of the year - when compared to the average deaths that occur in autumn and spring.

The official term used by the ONS is "excess winter mortality".

The elderly are especially vulnerable during the colder winter months but although there are more deaths in winter, few die directly as a result of hypothermia.

Continue reading the main story

"Start Quote

"We all have a role to play in remembering the needs of friends, relatives and neighbours who could be at risk especially at this time of year.""

End Quote Anne Milton Public Health Minister

Heart disease, flu and stroke are more much common causes of death.

The Department of Health says the figures are a reminder of the deadly impact cold weather can have on the elderly.

The Public Health Minister Anne Milton welcomed the fall in excess winter deaths but said the public needed to be prepared for another cold winter.

"We all have a role to play in remembering the needs of friends, relatives and neighbours who could be at risk especially at this time of year."

Age UK, the charity that campaigns for the elderly, said the figures seem to show some improvement.

But it said it was still unacceptable that tens of thousands of old people die as a result of cold weather.

The charity says the UK still has one of the highest winter mortality deaths in Europe.

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